Physicians who are licensed by the College of Physicians and Surgeons of British Columbia (CPSBC) are eligible to enrol with MSP and obtain MSP billing numbers.
Enrolment status, and, therefore, the possession of an active billing number, is contingent upon the practitioner's continued licensure by the CPSBC. Any change in licensure, such as the renewal of a temporary license or specialty, must be reported to MSP to avoid refusal of claims.
Licensed physicians who register with MSP are called "enrolled" physicians. Enrolled physicians may choose to be "opted-in" or "opted-out".
Opted-in physicians are physicians who are enrolled in MSP under Section 13 of the Medicare Protection Act and who elect to bill MSP directly for insured services provided to MSP beneficiaries. An opted in physician may not bill a patient directly for an insured benefit.
Opted-out physicians are physicians who are enrolled in MSP under Section 13 of the Medicare Protection Act and who elect to bill patients directly for insured benefits. The patient may then claim reimbursement from MSP. By law, an opted-out physician may not charge a patient more for an insured benefit than the prescribed MSP amount.
Physicians Who Are Not Enrolled
Unenrolled physicians are not registered with MSP. Consequently, services provided by a physician who is not enrolled or whose enrolment has been cancelled with MSP are not insured and are not reimbursed by MSP. By law, unenrolled physicians in B.C. may not charge patients more than the MSP amount for an insured benefit, unless the service is provided at a facility other than a hospital or community care facility, as defined by legislation.
Note: The prohibition of extra-billing for medical services does not apply to uninsured services such as cosmetic surgery, third-party medical services, etc. The charges for these uninsured services, including related pre-operative and post-operative visits, are to be paid by the patient.
Assignment of a Billing Number
Each practitioner enrolled with MSP is assigned a billing number consisting of two numbers:
- a practitioner number, which identifies the practitioner rendering the service; and
- a payment number, which identifies the person or group (e.g. clinic, hospital) to which payment is to be made.
The practitioner and payment numbers are usually the same. However, they differ in cases where a practitioner designates another practitioner or a group, such as a clinic or hospital, to receive that practitioner's MSP fee-for-service payments.
All claims submitted to MSP must include the practitioner number of the practitioner who performed the service; therefore, a practitioner cannot bill under another practitioner's number. The practitioner whose number appears on the MSP claim assumes full responsibility for the service provided.
Applying for a Billing Number
Physicians wishing to obtain a billing number from MSP must follow a clearly defined process.
1. You must first request licensure from the College of Physicians and Surgeons.
2. You must complete and submit the following application form:
Change of Address or Licence
If you change your address or telephone number, or if there is a change in your specialty or licence status, you must advise MSP so that your records can be updated accordingly. Timely notification of changes enables MSP to provide practitioners with accurate and efficient service and helps prevent unnecessary refusal of claims.
De-enrolment and Opting Out
A medical practitioner may:
- enrol with MSP (if licensed with the appropriate licensing body); or
- once enrolled, opt out of MSP; or
- once enrolled, de-enrol from MSP (cancel the enrolment); or
- not enrol with MSP.
If a medical practitioner intends to require their patients to pay all or a portion of the costs of a service, he or she must inform the patient, prior to rendering the service:
- that the patient will be required to pay part or all of the cost directly;
- the amount the patient will be required to pay; and
- the amount the patient can expect to be reimbursed by MSP.