Payment of Fee-for-Service Claims


»  Payment of Claims
»  Assignment of Payment
»  Emergency Payment
»  Practitioners' MSP Premiums

Payment of Claims

MSP accepts claims for medically required services that are MSP benefits, provided by practitioners who are enrolled 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:

Practitioners who submit claims for fewer than 2,400 services per year and earn less than $72,000 annually in fee-for-service payments may submit their accounts on claim cards available from MSP. Claims submitted by claim card are subject to a charge of 40 cents per paid service plus applicable GST. MSP deducts these charges from the statement. If you are eligible to submit claim cards, contact Provider Services.

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.

The time required to process claims varies, depending on whether they are submitted electronically or by claim card. 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. Claims submitted by claim card take longer to process. 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 by claim card 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.

MSP Premiums for Practitioners

Practitioners can arrange to have their MSP premiums deducted from their mid-month MSP remittances. This method of premium payment does not affect the amount payable to MSP or the benefits provided by MSP. Practitioners who want to arrange premium deductions should apply in writing providing:

  • physician's name;
  • billing number;
  • residential address;
  • business address (both office and mailing address if they are different);
  • business telephone number; and
  • MSP account number (from premium invoice) or Personal Health Number (from CareCard).

Practitioners who pay MSP premiums for persons not covered under their own MSP account can also arrange for these premiums to be deducted from the mid-month remittance by submitting the following information:

  • all the details listed above;
  • the names of the other persons whose premiums are to be paid; and
  • the MSP account numbers or Personal Health Numbers for those persons.

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