When doctors provide insured services under the Medical Services Plan they submit a claim for payment. These claims identify the service provided, the patient, and a diagnosis. The Medical Services Plan pays over 58 million claims a year. These claims cover more than 90 per cent of all physician services provided in the province. Services which are not captured are:

• those paid by the Workers' Compensation Board;
• those paid by the Insurance Corporation of British Columbia;
• some services provided under alternate payment arrangements; and,
• services provided outside British Columbia.

An active audit program ensures a high level of accuracy except for diagnostic coding. Diagnoses are reported using the International Classification of Diseases, version 9 (ICD9). Only one diagnosis is reported on a claim. Patients may have a number of disorders, and there are a variety of possible codes that can reasonably be used for any given situation. As a result, the codes are not a totally reliable indication of the reason that a service was provided. Review suggests that, for the purposes of monitoring chronic diseases, the coding should be considered 90 per cent accurate.

Last Revised: February 14, 2007