Depending on whether you are opted-in or opted-out, there is a choice of two Teleplan Service Application forms. To access the forms, see Teleplan Service Application form. Then, print out the needed one and fill it in by hand.
Name, Mailing Address, etc.
You should have no difficulties filling out the first part of the form such as your name, mailing address or type of facility. Just remember to write down your mailing address correctly because it will be used for WCB and MSP correspondence.
Data Centre Information
While filling out TELEPLAN CLAIM SUBMISSION INFORMATION section of the Teleplan Service Application Form, it is important to correctly identify Data Center you are going to use for your claim submission.
- If you are a solo practitioner or if you are the first therapist in your clinic applying for Teleplan, fill in NEW DATA CENTRE section. Choose the name for your Data Centre and write it down on the Name line. On the Contact line put your name and your contact phone number.
- If you want to join a Data Centre Number that has already been assigned to other practitioners in your clinic, choose JOINING EXISTING DATA CENTRE option. Put the name and the number of the existing centre on the Name and Data Centre No lines.
For more info on joining existing Data Centre, see Sharing Data Centre Number.
Payee or Payment Number
When you fill out an application for Teleplan service, you are also required to write down your personal Billing Number on the line MSP Payee Number for opted-in therapists and on the line Your current MSP payment number for opted-out therapists. Be careful not to put the Billing Number of your group instead of your own if your group has one.
System
Hardware
Providing information about your hardware configuration will help Teleplan support centre to troubleshoot claim submission problems.
Billing/Business software
Software Name: Claim Manager MT
Vendor: TripleTee.com
Supplier: TripleTee.com