What is an explanatory code?
What is an explanatory code?
In certain circumstances, MSP may reject, reduce or refuse payment on a claim submitted by a health care practitioner. In each case, explanatory codes accompany the rejection, reduction or refusal in order to provide the practitioner with the reason for their claim not being paid in full.
What is the SOMB?
Schedule of Medical Benefits (SOMB) is the fee schedule and list of medical benefits insured under the Alberta Health Care Insurance Plan.
How much is a doctors appointment in Alberta?
Alberta’s current fee-for-service model allows family doctors to bill $41 as a base fee for each patient visit no matter how short or how long.
What is reciprocal billing?
Under the reciprocal billing agreements, insured hospital in-patient services are payable at the hospital’s standard ward or ICU per diem rate, as established by the host province/territory. Information on the reciprocal billing arrangement for physician claims is not included in this manual.
What are the MSP codes?
Medicare Secondary Payer (MSP) Condition Codes
| Condition Code | Report When |
|---|---|
| 02 | Employment-related condition |
| 03 | Patient covered by other insurance not reflected here |
| 05 | Lien has been filed |
| 06 | ESRD patient in 1st 30 months |
How do I contact MSP BC?
Telephone: Call 1-800-661-2668 (toll-free in B.C.) or (250) 952-2657 (in Victoria). This is the automated TAP line at Health Insurance BC (HIBC) and the physician’s MSP Payee Number is required for entry. Facsimile: Fax your request to HIBC Provider Services at (250) 405-3592.
Is dermatology covered by Alberta Health Care?
How much does dermatologic treatment cost? If you are insured, Alberta Health will cover the costs of your basic medical investigations and treatments. However, many medical dermatology treatments may be covered under insurance plans, and we will help ensure you receive maximum benefits.
How much is medical in Alberta?
Health and dental coverage starting from $76.10 per month! All residents of Alberta must register themselves and their dependents with AHCIP in order to qualify for benefits. Generally speaking, any service that is deemed medically necessary is covered by AHCIP.
What is the first step in the billing revenue cycle?
The first step in revenue cycle management is pre-authorization and registration. This is the point at which you gather the patient’s insurance and financial information.
What is the Q6 modifier used for?
Submit HCPCS modifier Q6 to indicate that services were provided under a locum tenens arrangement. The regular physician generally pays the substitute physician a fixed per diem amount.
What is an explanatory code? In certain circumstances, MSP may reject, reduce or refuse payment on a claim submitted by a health care practitioner. In each case, explanatory codes accompany the rejection, reduction or refusal in order to provide the practitioner with the reason for their claim not being paid in full. What is the…