Payment of Fee-for-Service Claims

»  Payment of Claims
»  Assignment of Payment
»  Emergency Payment

Payment of Claims

MSP accepts claims for medically required services that are MSP benefits, provided by practitioners who are enroled with MSP and in good standing with the licensing body governing their profession.

MSP pays practitioner claims in accordance with the provisions of the Medicare Protection Act and Regulations, the relevant payment schedule, and MSP claims policy and procedures. The fees in the payment schedules are established through consultation between Medical Services Commission and the respective professional associations.

Practitioners billing on a fee-for-service basis must submit claims to MSP in a computer-readable format within 90 days of the service date. Claims can be submitted via Teleplan or by contracting with a service bureau equipped to make the submissions. Depending on your status with MSP, there is a choice of two forms to apply for Teleplan service:

• Application for Teleplan Service - Opted-in
• Application for Teleplan Service - Opted-out

Practitioners who submit claims for fewer than 2,400 services per year and earn less than $72,000 annually in fee-for-service payments (who do not submit to MSP via TelePlan) may now submit claims online free of charge with the Pay Practitioner and Pay Patient Claim forms available at: www.hibc.gov.bc.ca.

After September 30, 2012 Claim Cards or Claim Forms submitted by mail will no longer be processed except for the claim types listed below.

The following claim types are permitted exemptions and claims may be submitted by mail using the downloadable “Fill, Print and Mail” format:

• Pay patient claims for opted-out practitioners
• Correctional facilities claims
• Dental claims
• Reciprocal claims
• Claims for patients covered under the Critical Care Coverage Program

If a practitioner can demonstrate that they reside in a community without internet access or that obtaining internet access will cause significant financial hardship, they can submit their claims via mail using a Claim Form. Practitioners must request an exemption in writing demonstrating that obtaining internet access will cause significant hardship. Requests for an exemption should be sent to Health Insurance BC.

Payment of claims is made at the middle and at the end of each month, either by direct bank deposit (electronic funds transfer) or by cheque. To apply for direct bank deposit, complete an Application for Direct Bank Payment or Request for Change to Banking Information. Health care practitioners who are opted-out of MSP receive payment for services provided at the end of each month.

A payment for claims submitted via Teleplan normally includes claims received at least seven days prior to the next payment date. However, if the claims information is incomplete or inaccurate, or if the claim requires manual adjustment, processing and payment of the claim may be delayed. A few days prior to the payment date, the Claims Processing System issues a remittance statement or payment summary record for the payment period. Practitioners billing electronically receive their statements electronically; those billing through online forms submission receive their statements by mail.

Assignment of Payment

An assignment of payment is a legal agreement through which a practitioner designates that MSP payments for his or her services are to be made to another practitioner or to a group such as a clinic or hospital. MSP refuses claims submitted before the assignment processing has been completed.

There are three types of payment assignments:

Locum Tenens - When one practitioner replaces another during holidays or sickness, payment for services may be made either to the principal practitioner or to the practitioner providing the service in the absence of the other. The assignment must be limited to the specific period of coverage. To apply, complete an Application for Assignment of Payment form.

Clinic or Associated Group - Practitioners may assign payment to a clinic or group practice. Normally the clinic or group has a single payment number. The term of the assignment may be for any period up to, but not exceeding, five years. If the term is to be extended, new assignment forms must be completed and submitted prior to the expiry of the current term. Fill out an Application for Assignment of Payment form to apply.

Diagnostic Facility or Hospital - This type of payment assignment (with its own separate form) allows medical practitioners to assign payment to a diagnostic facility or hospital for specific services such as EMG, Laboratory Medicine, Nuclear Medicine, Pulmonary Function Studies, Radiology and Ultrasound. The term of the assignment may not exceed two years. Complete an Assignment of MSP Payments for Diagnostic Facility Services form to apply.

Emergency Payment

MSP has developed an emergency payment system for those who receive their payment by direct bank deposit, to ensure there is no disruption in payment if claims cannot be processed due to a labour disruption or any major system problem. This amount is based on the average payment over the last 12 months, or if you have been practicing for less than that, a formula will be used to determine the eligible amount.

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