ESI Canada

ESI Canada is a leading health claims management company that is redefining health claims solutions to bring the best available service to our clients and providers. We serve 5 million members and help insurance carriers, third-party administrators, and the public sector navigate the rapidly changing benefits landscape.

Our Mission
Our Approach

Our Mission (Top of Page)
"ESI Canada's mission is to be a leader in progressive healthcare initiatives by employing its professional expertise, leading-edge information management systems, and technology to ensure high-quality, cost-effective healthcare products to its customers."

Setting the pace in the Canadian benefit management market with world-class technology and innovative products, ESI Canada has experienced major growth in membership and claims volume during the past few years.

ESI Canada acts as an intermediary among insurance companies, third-party administrators, plan sponsors, healthcare providers, and plan members. We provide a complete dental, healthcare, and pharmacy benefit management solution to our customers.

Some of the specialized services ESI Canada offers include the following:

• Benefit plan management and design
• Clinical programs
• Innovative and flexible claims adjudication
• Point-of-service claim utilization review
• Prescriber, provider, member, and processor audits
• Provider network management
• Research
• Retrospective analysis and simplified reporting
• Training and education

As it becomes more challenging to keep up-to-date on advances in dentistry, health, and pharmaceuticals, ESI Canada has an increasingly important role to play. ESI Canada strives to enhance quality care while using a benefit management approach.

ESI Canada's customers benefit from the following:

• Exceptional service levels that consistently exceed customer expectations
• Group insurance expertise across all levels of the organization
• Health management experts to support benefit management programs
• Marketing strategies designed to fulfill each customer's business needs
• Partnership approach to meet individual customer needs
• Personalized service from a highly skilled customer services team
• Quality services based on a firm belief in customer input and satisfaction
• Technology-based solutions that provide tremendous flexibility

Our Approach (Top of Page)
Today, effective benefit management has moved far beyond efficient claims processing. Although claims processing is still our core service, ESI Canada has kept ahead of the fast-paced evolution of the health industry by investing in the technology, research, and talented people it takes to be an innovator. ESI Canada has pioneered clinical programs and services that improve benefit plans and help customers successfully navigate the benefits landscape.

ESI Canada provides its customers with an integrated, customized package of benefit management products and services including dental, health, and pharmacy claim adjudication services that help improve healthcare quality and manage healthcare costs.

Our core benefit management services include the following:

Claim Management

• Fast and efficient online claims processing captures claim information at the point of service
• Claim payments to dental and healthcare providers
• Exceptional flexibility in plan design, down to the individual plan member
• Online access to information
• Ability to make online changes to eligibility information
• Detailed reports that monitor your various benefit programs, track results, and prove that ESI Canada capabilities and services make an impact

Benefit Management

• Flexibility to combine benefits and deductibles under a common accumulator for all benefits
• Dental fee guides, Reasonable and Customary (R & C) limits for health services, and drug pricing files
• Dental, health, and clinical consultative services
• Audit services that ensure that only appropriate claims are paid

Provider Management

• Provider network management
• Provider Call Centre to handle questions from dental and healthcare providers
• Dental, healthcare, and pharmacy claims data integrated to allow you to target interventions for healthcare providers

Customer Relationship Management

• Account management team that works to promote a smooth implementation of your benefit program
• Marketing support for private-label branding
• Ongoing customer support
• Input into system changes
• Special committees that focus on different aspects of benefit management

• Benefit card production and delivery
• Data entry of paper claims
• Production and delivery of member cheques and explanation of benefits (EOB) statements
• Adjudication of settled claims