Advertisement

About Reimbursement Wiki

A free, practical knowledge base built for the people who navigate Canada's drug reimbursement system every day.

What this is

Reimbursement Wiki is a free, publicly accessible resource for Canadian Patient Support Program (PSP) Case Managers, pharmacy technicians, and healthcare coordinators who work with private insurance plans and drug coverage programs.

The reimbursement landscape in Canada is complex — each insurer has its own portals, timelines, quirks, and unwritten rules that only experienced professionals know. This wiki exists to make that knowledge available to everyone, whether you are new to the field or a seasoned case manager looking for a quick reference.

All entries are datestamped so you always know how recent the information is. Users are encouraged to add their own tips and help keep the database current.

Why it exists

Case managers in PSPs spend hours each week navigating insurer-specific processes that are rarely documented in one place. Turnaround times change. Internal routing policies shift. Plan quirks get discovered only after a claim is rejected.

This wiki was built to be the resource that experienced CMs wish they had when they started — and that current CMs can rely on as a trusted, up-to-date reference during active patient cases.

What you will find here

SA/PA timelines
Current processing times for Special and Prior Authorization submissions by insurer, updated as they change.
Plan quirks
Unusual plan configurations, crossover arrangements, and insurer-specific rules that trip up even experienced CMs.
Submission tips
Best practices for submitting claims, avoiding common rejection reasons, and following up effectively.
Formulary info
Notes on drug tier status, coverage conditions, and formulary update cycles by insurer.
Portals & contacts
Where to submit, how to follow up, and the right channels for each major insurer.
General guides
Foundational knowledge on terminology, processes, and differences between provincial and private coverage.

Insurers currently covered

The wiki includes entries for all major Canadian private insurers and adjudicators:

Manulife Sun Life Canada Life Desjardins ClaimSecure Green Shield Canada Blue Cross TELUS Health Other / General

How to contribute

Anyone can add an entry using the "Add entry" button on the main wiki page. There is no account required. Simply provide a clear title, select the insurer and topic, write your tip, and confirm the date. Your contribution will be visible immediately.

We ask that contributors share information based on professional experience, publicly available insurer documentation, or verifiable sources. Please do not submit patient-specific or confidential information.

Disclaimer

The information in this wiki is provided for general reference purposes only. It is crowd-sourced from professional experience and publicly available insurer documentation, and may not reflect the most current policies of any given insurer. Always verify critical information directly with the insurer before making decisions that affect patient coverage. Reimbursement Wiki is not affiliated with, endorsed by, or sponsored by any insurance company.

Start using the wiki

Browse entries, filter by insurer, and add your own tips to help the community.

Open the wiki