What is the effective date of the change?
Members will use TELUS AdjudiCare for benefit claims (and transition off of Nexus) effective September 6, 2022.
How will this change impact me?
- You’ll receive a new member ID card.
- Some plans will be getting a new policy number, which is referred to as a “group number” in the TELUS system.
- There will be no changes to your member certificate number.
- TELUS AdjudiCare offers online claim submission and real-time adjudication of most claims. This shortens the turnaround time for claims processing from 5 days to next day, which is a significant improvement.
- There is a new online portal and mobile app to submit claims, check benefits, and view claims history. If you wish to claim using the online portal or mobile app you will be required to enable direct deposit in TELUS AdjudiCare.
- Direct deposit information will not be transferred over from the Nexus system. You will need to register for the new online portal and/or mobile app and reset your banking information to enable direct deposit in TELUS AdjudiCare.
- Work & Wellness Life and Disability benefits and claims, if applicable, will not be impacted.
When will I receive my new member ID card?
Pacific Blue Cross will print and mail new member ID cards in mid-August.
How do I access the new online claims portal?
Open your web browser and go to My PBC Benefits to register your account on the new system. Remember to have your banking information handy so you can set up direct deposit at the same time.
Or, you can go to the Apple App or Google Play Stores and download the My PBC Benefits app.
We encourage you to set up your claims portal access as soon as you receive your new ID card, but you won’t be able to submit claims until September 6th.
Who will I call with enquiries about my benefits?
After September 6th there will be a new, centralized toll-free number that Pacific Blue Cross National members will call for plan information and assistance. This number will connect to PBC’s call centre, which will be available during our business hours, from 8:00 – 4:30 pm PST, Monday to Friday. The Call Centre has French language speakers to assist with translation for our French-speaking members.
Toll free: 1-866-366-0430
You can also email us by using the Contact Us form.
Will my claims history be transferred from Nexus to TELUS?
Yes. We will have your claims history on the TELUS system by the effective date. You will be able to view your claims history in the new online claims portal at mypbcbenefits.onlineclaimsaccess.net or the mobile app.
Will health care providers be advised of the transition from Nexus to TELUS AdjudiCare?
Yes. Pacific Blue Cross will be communicating with providers to inform them of this transition. Additionally, all the Blue Cross organizations that are impacted by this change are collaborating on a national communications strategy to help providers across the country navigate this change. TELUS will also be communicating this change through its provider network.
Plus, our newly issued member ID cards will clearly state that providers should use TELUS to submit their claims and pre-determinations. It’s really important that you show your new ID card to your providers.
Are there any differences between the Nexus and TELUS systems that will impact claims administration?
As with any transition from one system to another, there may be some slight nuances in how claims are adjudicated. However, we are doing everything we can to facilitate a smooth transition for members.
One significant change to be aware of: TELUS AdjudiCare offers online claim submission and real-time adjudication of most claims. This shortens the turnaround time for claims processing from 5 days to next day. A big improvement!
Do I still have access to the Blue Advantage® program?
Yes, along with many other member benefits such as personal travel insurance and trip cancellation policies and more affordable prescriptions through our Preferred Pharmacy Network.
Will I still be able to access the Group Member Portal for the Blue Cross National members after September 6th?
No. You will no longer have access to the old claims portal, but you can still access your “old” history through the TELUS member website.