Enhanced Urgent Care Coverage Program

Under the 2022 Physician Master Agreement, the Enhanced Urgent Care Coverage Program (EUCCP) is a two-year pilot project that builds on the Critical Care Coverage Program by improving the criteria for physicians to claim compensation for urgent services provided to British Columbia (B.C.) residents who are eligible for enrolment in MSP but who are not enrolled.

Services to non-B.C. residents and B.C. residents who have elected to opt out of MSP or are within the mandatory wait period are not covered by EUCCP.  

Pilot Phases

Implementation of the pilot will follow a three-phase approach:

• Phase 1 involves launch and processing of the claims forms.
• Phase 2 involves working with Health Authorities to develop wraparound supports.
• Phase 3 involves evaluating the pilot.

Criteria 

The patient must present in a B.C. emergency department with at least one of the following conditions:  

• Medical assessment of the individual presenting at the emergency department, such as to assure the attending physician that there is not otherwise a risk to the patient’s long term health; 
• Urgent medical need requiring professional attention that could threaten an individual’s life or long-term health if delayed;  
• Unconsciousness;  
• An emergency condition that requires immediate admission to an intensive care unit; or 
• A required involuntary admission under the Mental Health Act. 

Patient identification and proof of residency must be confirmed and documented. If obtaining acceptable primary identification and proof of residency is not possible due to circumstances, an Attestation Method can be used. 

Under the Medicare Protection Act, enrolment with the MSP is mandatory for all eligible B.C. residents. To assist patients to complete their enrolment in MSP, please direct them to the British Columbia Application for Health and Drug Coverage. 

The EUCCP is not intended to pay for services provided to individuals not eligible for MSP enrolment and will not cover patients who are within their MSP coverage wait period.  

Claims 

The EUCCP claims submission consists of two forms: 

• HLTH 1980 records the details of the patient’s eligibility for insured services, including attestation information where applicable; 
• HLTH 1915 records the details of the services and fee item claims. 

Both forms must be included in each mailed claims submission.  Digital submission is not available at this time. 

Physicians may only claim EUCCP if they have not received payment for services through other means. Physicians must complete and remit forms that capture information about the patient and need criteria, as well as specific claims details. These are required for all submissions. 

Subsequent continuous services provided to a patient while admitted to a hospital can also be claimed until the patient is discharged or leaves. For subsequent extended services, a copy of the EUCCP form-documented patient identification and residency or attestation from their initial admission must be used along with the completed physician(s) extended services claims details form. 

The completed forms and supporting documents must be mailed to: Health Insurance BC, Medical Services Plan, PO BOX 9689 STN PROV GOVT, Victoria, BC V8W 9P8. 

More details and instructions are available in the Enhanced Urgent Care Coverage Program form.