October 1, 2010 Ministry of Health Fee Update

- For changes to the Schedule of Benefits for Physician Services, click here or contact support for more information.

Primary Care Ministry of Health Guidelines

- Comprehensive Care Model and Family Health Group Physicians
- Information and Procedures for Claiming the Cumulative Preventive Care Bonus
- Primary Care Nurse Practitioners: Special Premiums and After Hours Services
- Preventive Care Bonus - Tracking and Exclusion Codes

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Common Explanatory Codes

I2 – Service is globally funded
This explanatory code will appear on the monthly RA if a claim is submitted for a complement funded service for an enrolled or non-enrolled patient. The claim will pay at zero dollars.
I6 – Premium not applicable
This explanatory code will appear on the monthly RA if a Q code is billed for a patient who is not enrolled in the MOHLTC database on the service date. The assessment code billed along with the Q code will be paid (subject to all other MOHLTC rules).
I9 – Payment not applied/expired
This explanatory code will appear on the monthly RA if a Q200A is billed by a HIV Physician whose payment eligibility period for the Q200A has ended. The patient is successfully enrolled on the MOHLTC database; however the $5.00 PPRF will not pay.
30 – This service is not a benefit of MOHLTC
This explanatory code will appear on the RA for claims using the Q020A, Q021A, and Q022A tracking codes. The tracking codes are billed at zero dollars and will pay at zero dollars with an explanatory code 30.

Common Rejection Codes

A2A – Outside Age Limit
The service has been billed for a patient whose age is outside of the criteria for that service.
A3H – Maximum number of services
The number of services on a single claim for a Q012A code is one.
AD9 – Not allowed alone
Claims are being submitted without a valid assessment code on the same service date.
EPA – PCN billing not approved
Claim for Q code submitted for a patient with a service date prior to the physician’s effective date, or a claim for a Q code for which a physician is not eligible.
EP1 – Enrolment transaction not allowed
A Q200A code submitted for a patient with an incorrect version code, or who is either enrolled with another physician with the same effective date, or for a patient who should contact their local MOHLTC office regarding their eligibility. HIV Model Billing and Payment Fact Sheet 25 of 28 Version 1.2 December 2009
EP3 – Check service date/enrolment date
A Q200A has been submitted by a physician for a patient that already has an existing enrolment to the same physician with a different date.
EP4 – Enrolment restriction applied
A Q200A code submitted for a patient who has attempted to enrol with another family physician before six weeks has passed or attempted to enrol with more than two physicians in the same year.
EP5 – Incorrect fee schedule code for group type
A Q-code submitted is incorrect for group type.
PAA - No Initial Fee Previously Paid
A Q042A has been submitted with a service date that is not within the 365 day period following the service date of a Q041A fee code. /p>

Tip of the Month (November 2010) - Backup

Why is data backup important? Data is raw information written to a computer. Data can be letters, documents, pictures, reports, media, or patient information. Essentially everything that is on your computer is some form of data and it is normally stored in files and/or folders on your computer. At anytime, a disaster can wipe out crucial information on your computer permanently. This is why data backup is so important. When computers are used for data entry, data is first stored on computers, but after that, the back up needs to be stored on a different device or medium. Without proper backup you run the risk of permanent data loss. Theft, fire, water damage, computer malfunctions, viruses and other problems can cause all your hard work to suddenly vanish.. Read More.