Teleplan: Claims Submission and Processing
MSP is revising the location codes used in submitting claims. Teleplan vendors have been notified and are implementing upgrades to their products - see the Letter to Teleplan Vendors (PDF 36Kb). Practitioners will receive their upgrades according to the regular schedule of their software maintenance contracts.
Where do your billings go after they leave your office? They enter into the MSP claims processing system through the electronic claims submission system called Teleplan.
» About Teleplan
» Teleplan Specifications
» Claims Processing System
» Claims Processing for ICBC and WCB
» Zapping Erroneous Claims
» Teleplan Support Centre
Teleplan Web version 4.0 is a web-based telecommunications system used by practitioners to securely submit claims, notes and eligibility requests to MSP, and receive payment statements, rejected claims and patient eligibility data from MSP through an encrypted Internet connection. (For information about the conversion from Teleplan-DOS to Teleplan4, see Teleplan Conversion.) Teleplan is built to industry standards for secure Internet communications (like that used for online banking transactions).
Teleplan receives and processes over 5 million claims monthly, valued at approximately $116 million. Approximately 95% of all claims are processed within 30 days, with the majority being paid within 14 days. Processing times depend on the timing of the submissions and the complexity of the claims. Payments are made at the middle and end of each month, either by electronic funds transfer or by cheque.
Depending on your status with MSP, there is a choice of two forms to apply for Teleplan service:
The benefits of using a web-based Teleplan connection include:
- You can connect directly through a private Internet Service Provider (ISP) through dial-up or high-speed access (cable or ADSL). Contact the Teleplan Support Centre for information.
- Claims can be submitted electronically 24 hours a day, 7 days a week.
- You have direct online access to additional information and services through the Internet technology, including:
- enhanced patient eligibility check;
- a comprehensive MSP web site with access to online forms, interactive billing tutorials, electronic versions of the MSC Payment Schedule and ICD9 coding manual, the MSC Financial Statement, Physicians' Newsletter and other publications; and
- PharmaNet data.
For technical requirements and instructions about submitting electronic claims to MSP, see Teleplan Specifications.
Claims Processing System
Claims processing involves four major sequential components.
Step 1: Pre-Edit - This component, which runs nightly against approximately 250,000 electronic (TelePlan) claims, performs the following tasks for each claim:
- Verifies the billing number to ensure it is approved for that site.
- Checks all fields to ensure the values have been submitted in the correct format and with valid codes (e.g., valid PHN, valid fee items).
- Checks mandatory fields to ensure they contain data.
- Rejects the claim if it does not meet these data requirements.
- Codes the rejected claim to indicate the rejection reason and returns it to the submitter electronically.
Step 2: Eligibility Edit - This component, which runs nightly against both electronic (TelePlan) and online form submission claims, performs the following tasks for each claim:
- Verifies the match between the PHN and the patient name.
- Verifies that the amount billed is consistent with the fee item.
- Verifies that the physician is authorized to bill for the service.
- Rejects the claim if it does not meet these data requirements.
- Returns erroneous electronic (TelePlan) claims to the submitter for
- Identifies rejected online form submission claims for manual review.
Step 3: Adjudication - This component, which runs twice monthly, uses approximately 5,000 automated payment rules in assessing claims:
- Verifies billings of physicians that are dependent on other physician claims (e.g., surgical billing matches for anaesthetic and/or surgical assistant claims).
- Provides electronic explanatory codes for adjusted or refused claims.
- Fewer than 3% of claims are adjudicated manually.
Step 4: Payment and Remittance - This component, which runs twice monthly, performs the following tasks with each run:
This component also contains the Broadcast Message program.
- Processes over 2.5 million claims from 10,000 practitioners.
- Processes all third-party and audit-recovery items.
- Handles adjustments that may be applied to gross payments, including retroactive payments, interest, carrying changes and GST charges.
- Approximately four days prior to remittance date, sends electronic remittance statements to submitters, advising of payments to be made on the remittance date (this does not occur for forms sent through online submission.)
Claims Processing for the Insurance Corporation of B.C. (ICBC) and Workers' Compensation Board (WCB)
MSP acts as a claims processing agent for ICBC and WCB. This partnership streamlines the billing process for registered practitioners as they only have to submit claims to one agency.
Zapping Erroneous Submissions
If you discover that your Teleplan submission contains incorrect billings, you can arrange to have the submission returned to you for correction before it is processed if you notify the Teleplan Support Centre by 5:00 pm on the same business day that you made the submission.
The entire submission will be "zapped" and returned the next day with the explanatory code FC. You can correct and re-submit the claims immediately.
If you discover an incorrect submission after the transmission day but before MSP closes off a claims period to process payments, you may still contact the Teleplan Support Centre for assistance. You will be asked to identify the specific claims by Data Centre, Payee Number and Sequence Number. These records will then be rejected, but will not be returned until after MSP has issued your next remittance statement. Again, the explanatory code FC will be used for the returned claims.
Teleplan Support Centre
The Teleplan Support Centre handles questions about both Teleplan and the Claims Processing System, including:
- electronic billing problems
- electronic remittance statements and refusals
- MSP-practitioner-vendor liaison
- "zapping" claims submitted with incorrect data
- resetting revoked passwords, and
- hardware and software problems.
For questions about Teleplan and the Claims Processing System, contact the Teleplan Support Centre.
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