Claims & Anti-Fraud Affiliates

These organizations are primarily focused on the adjudication of health or dental claims.

Interested in joining as a Claims & Anti-Fraud Affiliate?
Please send your inquiry to affiliates@clhia.ca.

The Alberta School Employee Benefit Plan (ASEBP) is more than health insurance—we’re health champions. We provide sustainable, holistic health benefits, programs and services and are there to support you and your employer throughout your personal and workplace wellness journeys. Our benefit plans and services cover the full spectrum of the health journey, including general health, employee and family assistance and loss of life and disability benefits. They are designed and continually improved using our knowledge of the public education sector in Alberta, and we work hard to develop innovative solutions that promote, protect and improve the overall health of you and your dependants every step of the way. And because no one should have to worry about health benefits, we make sure the plan is financially safe, secure and tailored to meet your needs. Our model is a rarity in the traditional health insurance arena, and we’re proud to be the tailored, comprehensive option for the more than 140,000 Albertans impacted by our services.

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Founded in 1996 in Montreal, ASEQ | Studentcare is the leading provider of student health, dental, and wellness programs in Canada. The independent firm provides expert consulting, highly customized communications, and full administration services for Plans and serves over 1 million members at over 95 partner student associations, universities, and colleges.

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ClaimSecure™ is proud to offer 40 years of excellence in healthcare claims adjudication and web-based services. With our flexibility advanced communication and innovative technology, we’re committed to making healthcare management easy for customers across Canada. Connected to almost every healthcare practitioner in the country, our robust network enables us to deliver a consistent, cost-effective and seamless client experience. Our teams are ready to offer support clients and Plan Members various needs, using their extensive industry knowledge and diverse background experience. We offer access to Canada’s only fully automated communication adjudication matrix. This industry first technology provides real time coverage updates, via our online eProfile™ platform, managing your health faster & more convenient.”

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Express Scripts Canada, a registered business name of both ESI Canada and Express Scripts Canada Services, each an Ontario partnership indirectly controlled by Express Scripts, Inc., is one of Canada’s leading providers of health benefits management services. From its corporate headquarters in Mississauga, Ontario, just outside Toronto, Express Scripts Canada provides a full range of integrated pharmacy benefit management (PBM) services to insurers, third-party administrators, plan sponsors and the public sector, including health-claims adjudication and processing services, Home Delivery Pharmacy Services, benefit-design consultation, drug-utilization review, formulary management, and medical and drug-data analysis services, to better facilitate the best possible health outcomes at the lowest possible cost.

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IQVIA is a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry. Formed through the merger of IMS Health and Quintiles, IQVIA applies human data science — leveraging the analytic rigor and clarity of data science to the ever-expanding scope of human science — to enable companies to reimagine and develop new approaches to clinical development and commercialization, speed innovation and accelerate improvements in healthcare outcomes. Powered by the IQVIA CORE™, IQVIA delivers unique and actionable insights at the intersection of large-scale analytics, transformative technology and extensive domain expertise, as well as execution capabilities. With approximately 67,000 employees, IQVIA conducts operations in more than 100 countries. IQVIA’s insights and execution capabilities help biotech, medical device and pharmaceutical companies, medical researchers, government agencies, payers and other healthcare stakeholders tap into a deeper understanding of diseases, human behaviors and scientific advances, in an effort to advance their path toward cures.

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Founded in 1880, Johnson Inc. is one of Canada's leading Insurance and Benefit Consulting firms providing diverse programs and services to many Employers, Associations and Trusts across Canada. With locations from the head office in St. John’s, Newfoundland and Labrador to Langley, British Columbia, Johnson has approximately 1,500 employees in more than 65 locations across the country providing personalized service to our client organizations. Johnson is a leading provider of third party administration (TPA), specialized benefit and actuarial consulting and claims payment services (TPP). We have been offering these services for nearly 50 years, and we have several long-standing client partnerships spanning decades.

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Johnston Group provides benefit services to more than 30,000 businesses and their employees. With over $600 million in premiums under its administration, and over 40 years of experience, Johnston Group’s strength lies in its administrative capabilities.

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Manion, Wilkins & Associates Ltd. (MWA) is an independently owned Canadian firm that provides third party benefit administration, benefits payment and consulting services. We have been in business for over 30 years; initially specializing in the administration of multi-employer benefit plans and expanding to include claims payment and benefits consulting.

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Incorporated since 1984, MDM Insurance Services Inc. (MDM) is a fully integrated Third Party Administrator and Adjudicator of Short Term Disability (STD), Extended Health Care (EHC), Drug, Dental, Health Spending Account (HSA) and Personal Spending Account (PSA) benefits. An HSA can be established on a stand-alone basis, or, if in conjunction with a benefit plan, we offer client choice to allow for real-time integration. Our web based applications are designed for ease of use by Plan Members, Plan Administrators, Consultants and Providers. MDM’s pay direct card is accepted nationally. As a Pharmacy Benefit Manager we provide active formulary management , and in partnership with RxInfinity and SelectRx, a voluntary, national pharmacy Preferred Provider Network (PPN) and an active drug diversion program. Our tailored software allows complete customization of benefit plans. This, combined with competitive rates and unparalleled service offers clients a full solution option. MDM is committed to making the client our priority.

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NexgenRx is an Independent Canadian provider of ASO (Self-Funded) Drug, Dental and Extended Health benefit plans supported by technology. Incorporated in 2003 our head office is in Toronto, Ontario. We support our clients with a dedicated team of staff members, pharmacists, dental consultants, physician consultants and a bilingual call centre. We operate our own Pharmacy Benefit Manager (PBM) network, and our NexgenRx benefit/drug card is accepted at over 10,000 pharmacies and 18,500 dental offices across Canada. NexgenRx developed and operates a proprietary claims adjudication system along with our health care provider portal for real time claim submissions and processing. We are more than just a payor of claims we are also a technology partner. We not only adjudicate claims but also outsource our state-of-the-art technology and work with our clients to understand and meet their needs. We also offer a web based benefit administration solution which allows for one point entry of all benefits, regardless how many carriers you utilize for your pooled benefits. We offer an effective and customer sensitive approach to controlling cost in a world where health benefits are becoming more expensive for plan sponsors to offer.

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OTIP is a non-profit trust, directed by representatives from the four Ontario education affiliates, serving the education community for over 25 years.

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A leading North American eBusiness company, supplying solutions to the financial, insurance, Canadian health care and government sectors, TELUS Health Solutions Inc. is the largest pharmacy benefit management provider and largest private network for adjudicating drug claims and transmitting dental claims.

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