Eligible Clients and Services

Eligible Clients

The Personal Health Number (PHN) of an eligible MSP beneficiary must be included on claims submitted by a laboratory to MSP for payment of laboratory testing referred by RN(C)s. An eligible MSP beneficiary is defined as a person who is a resident of British Columbia and who is enrolled with MSP.

If an RN(C) refers a patient who is not enrolled with MSP for laboratory testing, a claim cannot be submitted by the laboratory through the MSP Teleplan claims processing system. The exception is for residents of other Canadian provinces/territories (except Quebec) for which a reciprocal billing system is in place. For referring reciprocal patients for laboratory tests, the patient’s medical insurance number from their home province/territory, birth date, and province code should be entered in the appropriate portion of the Standard Out-Patient Laboratory Requisition.

Please note that any laboratory medicine services referred for international patients without Canadian or BC medical insurance are not covered by MSP. Payment for these services is the responsibility of the individual.

“Reciprocal billing” means that medical and diagnostic claims and encounter records can be submitted to MSP for residents of other provinces/territories in Canada, except Quebec.

Verification of BC Services Cards or CareCards

The Ministry’s Investigations Unit conducts investigations into matters involving the possible abuse of MSP. The Ministry is concerned about BC Services Card and CareCard misuse, and recommends that health care practitioners make a complete check of CareCard information at all first appointments. If you suspect any unusual use of a CareCard, please request a second piece of picture identification to verify that the CareCard is being presented by the person named on the card.

Please notify MSP if you know or believe:

• a non-resident of B.C. is seeking medical services under a BC Services Card or MSP CareCard; or
• a person is in possession of another person’s CareCard; or
• a person is making false presentation or presenting false identification when seeking medical services under MSP.

To confirm a patient’s MSP coverage, call the automated Practitioner Information Line:

Victoria: (250) 952-3102 or (250) 383-1226
Vancouver: (604) 669-6667
Toll-free: 1 800 742-6165

This automated service handles coverage enquiries using an interactive voice response (IVR) system. The patient’s personal health number (PHN) must be provided.

If the PHN is unknown, fax a request on a coverage research form to: (250) 952-3101

Services that May be Referred by an RN(C)

The Health Professions Act and Nurses (Registered) and Nurse Practitioners Regulation permit RN(C)s to request certain laboratory medicine services approved by the CRNBC.

Standards for ordering laboratory services are set out in the CRNBC Standards, Limits and Conditions (PDF, 816KB) related to the scope of practice of RN(C)s.

When an RN(C) refers a patient for a laboratory test, the physician or facility performing the service cannot be paid appropriately for the service unless the Standard Out-Patient Laboratory Requisition includes the MSP practitioner number of the referring RN(C) and the laboratory test requested is a valid service that the RN(C) is permitted to request. It is very important that you only refer for those services which you are permitted to request to ensure that laboratory claims are not rejected.

Laboratory Services

RN(C)s are permitted to order a menu of laboratory medicine services approved by the CRNBC as within scope for registered nurses in certified practice. You are responsible to restrict your ordering to those tests approved for your specific certification category(s).

• Eligible Laboratory Services

Federal Government

Health care benefits for the following individuals are the responsibility of the federal government. These individuals have a federal health care insurance number:

• members of the Canadian Armed Forces; and
• inmates in federal penitentiaries (Correctional Services of Canada)

Note: Only the employed individual is covered by the federal government. Dependents of the federal employees are covered by MSP and are issued a PHN while residing in BC.

Prohibitions

Under the Medicare Protection Act and Medical and Health Care Services Regulation, certain restrictions apply to the submission of claims to MSP by medical and health care practitioners.

Services to a Family Member

It is recommended that an RN(C) not provide services directly to a family member. Examples of family members include spouse, mother, father, sister, brother, partner, daughter, son, mother/father-in-law, son/daughter-in-law, step daughter/son, etc. Please refer to the CRNBC Practice Standard on Nurse Client Relationships.

Delegation of Services

An RN(C) cannot delegate the provision of services to another person, except as specified in the CRNBC Standards of Practice for delegation to unregulated providers. 

Use of Another Practitioner’s Number

An RN(C) cannot request a service under another medical or health care practitioner’s number.

The RN(C) whose MSP practitioner number is recorded on the laboratory referral as the ordering practitioner assumes full responsibility for the service provided and acting on the results.