CLAIM SUBMISSION GUIDELINES. BY CLAIM TYPE.

Here are some further claim submission guidelines, conveniently listed alphabetically by claim type (we’re helpful like that).

HINTS…FROM THE EXPERTS.

Many claims can be submitted online by your health provider or you (via Plan Member Online Services or GSC on the Go™). If you have to submit a claim in the mail, pre-filled personalized claim forms can be found online via Plan Member Online Services.

Audio

For audio claims reimbursement, send a completed claim form and itemized paid receipts showing:

  • Patient name, address and GSC ID number
  • Audiologist name and address
  • Date and service received
  • Copy of audiogram
  • Breakdown of charges (i.e. acquisition cost, fee, mold)
  • Details of provincial funding, if applicable

Send to:
Green Shield Canada
Audio Claims
P.O. Box 1623
Windsor, Ontario
N9A 7B3

Dental

For dental predeterminations, forward:

  • Treatment plan estimate completed by your dentist
  • X-rays (your dentist can submit these online via our health provider portal – providerconnect.ca – so be sure to let them know)

For dental claims reimbursement, forward a dental claim form, completed by both the plan member and the dentist. If your claim is a result of an accident, a Dental Accident Report Form along with your dental x-rays must be submitted to GSC for prior approval.

Send to:
Green Shield Canada
Dental Claims
P.O. Box 1608
Windsor, Ontario N9A 7G1

Or you can submit dental claims directly through Online Services.

Monthly orthodontic claims can be submitted via Online Services or GSC on the Go.

Durable Medical Equipment (including prosthetics and medical devices/items)

For a pre-authorization, forward a pre-authorization form and a doctor’s prescription indicating the diagnosis and what is prescribed. For claim reimbursement, many medical items can be submitted online via Online Services. Or you can submit a paper claim. Just forward an original itemized paid receipt and claim form, including:

  • Patient’s name, address and GSC ID number
  • Health provider’s name and address
  • Date and charges for each service
  • A detailed description of the equipment

Send to:
Green Shield Canada
Durable Medical Equipment/Medical Items
P.O. Box 1623
Windsor, Ontario
N9A 7B3

Emergency Travel

GSC must be contacted by phone within 48 hours of commencement of treatment. Please call our Customer Service Centre at 1.888.711.1119 for detailed claim submission instructions.

General Extended Health

For claims reimbursement for extended health services like a diagnostic test or medical transportation, forward an original itemized paid receipt and claim form, including:

  • Patient name, address and GSC ID number
  • Health provider’s name and address
  • Date and charges for each service or supply
  • A detailed description of the service or supply
  • Medical referral when required (your benefit plan documentation will tell you if you need a referral)

Send to:
Green Shield Canada
General Health Claims
P.O. Box 1606
Windsor, Ontario N9A 6W1

Health Care Spending Account (HCSA)

Your HCSA claims can be submitted via Plan Member Online Services or GSC on the Go™. Or you can submit a paper claim. Just forward an original itemized paid receipt and claim form, including:

  • Patient’s name, address and GSC ID number
  • Health provider’s name and address
  • Date and charges for each service or supply

Send to:
Green Shield Canada
HCSA Claims
P.O. Box 1606
Windsor, Ontario N9A 6W1

Hospital Accommodation

For hospital accommodation claims reimbursement, forward a claim form and an original itemized paid receipt including:

  • Patient’s name, address and GSC ID number
  • Admission and discharge dates
  • Daily semi-private accommodation charges

Send to:
Green Shield Canada
Hospital Claims
P.O. Box 1615
Windsor, Ontario N9A 7J3

Paramedical Services (like physiotherapy, massage therapy, etc.)

For claims reimbursement, forward a claim form for related health professional services and an original itemized paid receipt including:

  • Patient’s name, address and GSC ID number
  • Health provider’s name and address
  • Date and nature of treatment
  • Charges for each service


Send to:
Green Shield Canada
Professional Services
P.O. Box 1699
Windsor, Ontario N9A 7G6

Or submit your claim electronically via Plan Member Online Services or GSC on the Go.

Private Duty Nursing

Pre-authorization is required from GSC prior to commencement of services. Please call our Customer Service Centre at 1.888.711.1119 for detailed instructions.

Orthopedic Shoes

For orthopedic shoes claims reimbursement, send a completed claim form along with the following documents:

  • Prescription from an eligible medical professional (like a physician) showing the medical diagnosis that requires the orthopedic shoe
  • An itemized receipt showing the date of pick up and that the payment was made in full; the receipt must include the make and model of the orthopedic shoe.

Send to:
Green Shield Canada
Medical Items
P.O. Box 1623
Windsor, Ontario
N9A 7B3

For custom footwear claims, a GSC pre-authorization form must be completed by your treating physician. In other words, your claim must be pre-approved by GSC before the claim will be accepted. Once you receive our approval, you will need to submit a receipt showing that the custom footwear was paid in full.

Orthotics (Custom)

To submit a claim for custom orthotics, send a completed claim form along with the following documents:

  • Prescription from an eligible medical professional (like a podiatrist) showing the medical diagnosis that requires the custom orthotic
  • An itemized receipt showing the date of pick up and that the payment was made in full
  • A description of the casting technique used to create the orthotic
  • A copy of the biomechanical examination or gait analysis performed
  • A detailed lab invoice showing:
  • Patient’s name
  • Date of invoice or shipping date
  • Materials used to construct the orthotic (if applicable)
  • Invoice number
  • From (lab name) and To (clinic name/dispensing provider name)

Send to:
Green Shield Canada
Medical Items
P.O. Box 1623
Windsor, Ontario
N9A 7B3

Vision

For vision claims reimbursement, forward a vision claim form completed and signed by the optical provider and an original, itemized paid receipt including:

  • Patient’s name, address and GSC ID number
  • Health provider’s name and address
  • Date of service (the date glasses or contacts are picked up)
  • Vision prescription
  • Breakdown of charges for lenses and frames (if applicable)

Send to:
Green Shield Canada
Vision Claims
P.O. Box 1615
Windsor, Ontario N9A 7J3

Or submit your claim electronically via Plan Member Online Services.

And don’t forget pre-authorization requirements…

If the cost of any proposed dental treatment or medical item is expected to exceed $300, please submit a detailed treatment plan from your service provider before you begin treatment. If a description of the procedures to be performed and an estimate of the charges are not submitted in advance, GSC reserves the right to make a determination of benefits payable, taking into account alternate procedures, services, or course of treatment, based on accepted standards of medical/dental practice. Here are some commonly used authorization forms:

For further information, please call our Customer Service Centre at 1.888.711.1119.