Standards of Service
The following document details Statgo’s Standards of Service. To ensure claims are processed in a timely and complete manner, please review the following Standards of Service. If you have any questions, please do not hesitate to reach out to us.
Statgo offers a number of convenient options for submitting your billings.
Self Entry: Statgo clients may use the Statgo software to enter their billings directly
Statgo Entry: Statgo provide 2 options for Sending Billing Sheets
- Secure upload of document in the Statgo software. Please label, tag and date the document appropriately.
- Fax document to Statgo. Your Statgo agent can provide a fax number to you.
- NOTE: If you fax us a document, we will upload your document to your Statgo account, usually within 2 business days of receipt. After faxing a document to Statgo, please confirm the document has been received by checking your documents tab.
- NOTE: Please do not send us emails or unregistered mail with any private patient information
Information required to submit your claims
For all claim types, please include:
- Date of Service
- Alberta Health Facility Name and Centre Code (if applicable)
- Full Patient Name
- Patient Alberta PHN, Out of Province healthcare number or private health insurance details
- Insurance Type (AHCIP, OOP, Private, etc..)
- Referring Physician (if applicable)
- Time and Duration of Service (if applicable)
- Health Service Code (HSC) appropriate to the relevant payer
- Modifiers (if applicable)
- Diagnostic Codes (if applicable)
- Encounter Number (if applicable)
- Supporting Text (if applicable)
- Any additional information relevant to submitting the claim
For reciprocal out of province claims, please include:
- Full patient demographics, including middle name, date of birth, gender, full address
For private claims, please include:
- Please provide full insurance details (policy number, contact for insurance company)
For Quebec claims, please include:
- Please provide their full Quebec address
- RAMQ number (PHN)
- Please have the patient sign the RAMQ form
NOTE: We cannot call patients on your behalf to obtain the above required information
NOTE: The information above is available on Alberta Netcare. Please let us know if you need assistance in locating this information.
Self Entry: Claims entered at any time prior to the HLINK’s 11:55AM Thursday submission cut-off will be sent for assessment
Statgo Entry: We will make best efforts to have billing documents uploaded to the Statgo system by end of day Thursday entered and submitted for the next week’s HLINK’s 11:55AM Thursday submission cut-off. See graphic below of AHCIP entry and submission timelines. Please note statutory holidays may impact these timelines.
WCB*/Medavie/Private claims often take addition time for submission as there may be back and forth to obtain relevant details/coverage information. However, in the setting of minimal need for additional information we typically send this claims to the payors within 10 business days.
NOTE: For clients with time sensitive WCB claims (example report fees), please discuss your submission process with your Statgo agent to set up an appropriate process to facilitate billing needs.
Rejected/Underpaid/Refused claims will be actioned or resubmitted within 5 business days.
Requests for Information and Clarification
We may require additional information or clarification to successfully and correctly process your claim. If we require additional information, we will send you a request within Statgo’s secure software. Please respond to these information requests in a timely manner to ensure the claims are processed promptly. Statgo offers physicians a weekly reminder email with a list of the open information requests. If a request is not responded and the claim passes the date of eligible submission, Statgo will resolve and close the claim.
Additional Information for WCB Claims
WCB provides Statgo (if approved by the client) with an electronic assessment report for reconciliation of claim payment status. However, WCB does not provide Statgo with notice if a claim is refused. For claims refused by WCB, a letter is sent to the physician’s address on the WCB file. We require a copy of this letter to take further action and resubmit the claim to Alberta Health. If you received a refusal letter from WCB, please promptly upload the letter to your Statgo account with a clear title to ensure the claim is processed within the Alberta Health submission window.
Addition Information for Private Claims
Statgo provides service to process invoices and collect payment from patients and insurance companies. Statgo does not process with any claims were potential legal action is communicated. If a patient or insurance company communicates that they cannot or will not pay an invoice for any reason, Statgo cannot proceed with processing the claim and the claim will be closed. If a physician engages with legal counsel or in any way communicates potential legal action to the patient or payer, Statgo cannot proceed with processing the claim and the claim will be closed. Statgo may provide referral to physicians to a collections agency to continue with alternative methods to attempt payment of the claim.
Statgo will make best efforts to communicate the the patient or insurance payer to collect payment on a private claim to a maximum of 2 hours of total cumulative time. If your claim requires additional time to process, we will notify you and if approved, bill an additional $50.00 per hour for time spent on the claim.
Additional Information for all Claim Types
Physicians are responsible for ensuring the legal validity of their claims. Statgo assumes no legal responsibility for invalid or fraudulent claims made by a physician. Statgo retains the right to refuse processing of a claim at any time at Statgo’s sole discretion.
Please let us know if there will be an extended period without any claim activity. Statgo may deactivate or close accounts with no claim activity for 6 months or more.
COMMUNICATIONS BETWEEN STATGO AND CLIENTS
Statgo Messaging Service
Statgo provides a secure messaging service within the Statgo software for communication regarding claims. Private patient information should only be communicated using Statgo’s software. Within Statgo’s Software, your Statgo agent will notify you with an “issue to resolve” for claims that require additional information. We will attempt to respond to messages within the Statgo software within 2 business days during workday hours (9-5 weekdays). Please note this timeline and the 90 day AHCIP submission window when responding to claims with an “issue to resolve.”
Statgo may send email requests for issues not related to individual claims. Please note Statgo will send 1 email request to the confirmed Statgo account email on file for the client. Please do not share send any patient information via email.
To communicate with Statgo via email, please use firstname.lastname@example.org. For emails received by Statgo, we target to respond within 2 business days.
For phone communication, please use the phone number provided on the contact page. We will attempt to respond to phone messages with 2 business days during workday hours (9-5 weekdays).
For privacy and security reasons, please do not communicate with your Statgo agent via other communication apps (WhatsApp, etc.) or phone texts.
Statgo’s working hours are 0900 to 1700 weekdays MST.