Billing and Payments

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.

Billing by Teleplan

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:

Billing by Forms

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 on the MSP forms page.

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.

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.

Payment of Claims

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.

Interpreting Remittance Statements

The remittance statement is a record of a physician's paid claims and adjustments for a given payment period. Payment and remittance statements are issued at the middle and end of each month.

The remittance statement displays the total gross and net amounts billed and paid for each payment, and shows adjustments such as interest payments and the Rural Retention Premium.

If you bill electronically, your remittance statement is transmitted to you electronically. The statement layout varies, depending on the billing software you use. If you wish to receive printed copies of your remittance statements on an on-going basis, you can arrange to have Provider Accounts mail them to you for 4 cents per service line.

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.

Re-Submitting Claims for Reassessment of Payment

If you disagree with how MSP has paid a claim, the most effective way to have the claim reassessed is to re-submit the claim with a note record indicating that you are requesting a reassessment and including a brief explanation.

Example:

Fee Item (FI) 13611 billed at 100% for laceration on arm and 00100 is billed at 50% with diagnostic code 780 (general symptoms) - patient was seen for migraine headache.

The 13611 is paid and the 00100 is refused with explanatory code “KB” in accordance with Preamble D. 8. d. Diagnostic code 780 is too vague to determine if there are two unrelated medical conditions.

FI 00100 at 50% is rebilled with diagnostic code 346 (migraine). This is paid because now it is clear that there are two unrelated conditions. 

If you are still dissatisfied with the outcome after re-submitting the claim, advise Practitioner and Patient Claims Support by phone or fax.

MSP is committed to ensuring timely and accurate payment of claims, although inadvertent errors do occur from time to time because of the volume and complexity of claims submitted. If you are routinely re-submitting a certain type or combination of claims because of incorrect payment, advise the Practitioner and Patient Claims Support Supervisor. 

Payment Dispute Process

  1. If a physician disagrees with MSP's payment of a claim, the physician re-submits the claim to MSP with a note record explaining the details (as indicated above) and additional information as appropriate.

If paper correspondence related to the re-submission is being submitted,"correspondence sent" should be indicated in the claim comment field.

The claim is then reviewed by one or more of MSP's adjudicators and/or medical and surgical advisors.

If the claim is >90 days from the date of service, submission code “X” should be entered in the submission code field.

Submission code X may only be used if the claim is resubmitted within 90 days of the remittance date of the original claim.

Billing Tip:  Remember to include additional information in the claim comment or note record field.

  1. If a physician disagrees with the payment recommended by the medical or surgical advisors, the physician requests a review directly to the Reference Committee.

Doctors of BC's Reference Committee meets approximately three times a year to review disagreements between physicians and MSP regarding payments  made by MSP for specific services, and recommends resolutions to these  disputes. The physician submits details of the service and claim to the  Committee, and MSP submits details of its adjudication and adjustment or  refusal of payment.

  1. The Reference Committee submits its recommendations to MSP.
  2. Although the Committee's recommendations are not binding, MSP tries to follow them as closely as possible when making its decision. MSP may refer Payment Schedule interpretation issues to the Tariff Committee for comment, and may refer significant controversy to the Medical Services Commission for a final decision.

For additional info about the payment dispute process, contact:

Reference Committee
Doctors of BC
115 - 1665 West Broadway
Vancouver, BC V6J 5A4

Phone: (604) 736-5551
Fax: (604) 736-4566