Physician’s Newsletter January 2015

Physician’s Newsletter

2 January 2015

CONTENTS

CONTENTS ................................................................................................................................................................. 2

MANITOBA HEALTH, HEALTHY LIVING AND SENIORS—INSURED BENEFITS CONTACT LIST ........................... 3

“NEW” CLAIMS PROCESSING SOLUTION (CPS) ................................................................... 4

“NEW”THE PERSONAL HEALTH INFORMATION ACT (PHIA) .............................................................................. 4

CLAIMS UNIT ............................................................................................................................................................ 5

Electronic User Sites—Remittance Download Instructions ............................................................................... 5 “New” Diagnostic Codes (ICD-9-CM)............................................................................................................... 5 Interest Rates–January 1, 2015 ........................................................................................................................... 7 Disposal Code 44 ................................................................................................................................................ 7 Timeline for Submission of Claims .................................................................................................................... 7 Chronic Disease Management (CDM) Tariffs .................................................................................................... 8 Midwifery Referrals and Provider Number ........................................................................................................ 9 Lab Services for Northern Ontario Residents ..................................................................................................... 9

OUT-OF-PROVINCE UNIT ....................................................................................................................................... 10

Reciprocal Billing ............................................................................................................................................. 10

PRACTITIONER REGISTRY ..................................................................................................................................... 11

Change of Electronic User Site ......................................................................................................................... 11 Change of Software Vendor ............................................................................................................................. 11 Change of Mailing Address .............................................................................................................................. 12 Changing or Closing Bank Account ................................................................................................................. 12 Important Message For Manitoba Physicians Regarding Insurance Registry (iReg) Release ......................... 12

THIRD PARTY CLAIMS ........................................................................................................................................... 13

Workers Compensation Board (WCB) Billings ............................................................................................... 13

PHYSICIAN’S MANUAL UPDATES ........................................................................................................................... 14

APPENDIX ................................................................................................................................................................ 15

Important Dates for 2015 .................................................................................................................................. 15 Holiday Closures .............................................................................................................................................. 15

Physician’s Newsletter

January 2015 3

MANITOBA HEALTH, HEALTHY LIVING AND SENIORS—INSURED BENEFITS

CONTACT LIST

Practitioner Registry Registration of new practitioners

General Line (204) 788-2567 Registration of laboratory and x-ray facilities

Email: practitionerregistry@gov.mb.ca Electronic funds transfers

Fee-for-Service practitioner payment enquiry

Request for forms including; Paper Claims, By Report,

Claim Query, and Practitioner Address Change cards etc.

Electronic User Site Maintenance New electronic site set up

General Line (204) 786-7225 Deletion of obsolete site

Testing for electronic billing

Vendor software changes

EPiCS (Electronic Practitioner integrated Claims Submission)

General Line (204) 786-7225 FOB holder, set up, delete and changes

Claims Unit Tariff number information

General Line (204) 786-7355 or ICD-9-CM Information

(204) 786-7202 Practitioner enquiries on paid, reduced and rejected claims

Claims Pending

Registration/Client Services New registration and status changes

General Line (204) 786-7101 Out-of-province temporary absences or permanent moves

1-800-392-1207

Patient Enquiry Patients or practitioners requiring information on eye exams,

General Line (204) 786-7367 chiropractic or insured services

Applications for dental, cosmetic/plastic surgery

Audit and Investigation Confidential fraud line

General Line (204) 786-7118

1-866-778-7730

Out-of-Province Unit Out of Country Medical and Hospital Claims

General Line (204) 786-7303 Out of Province Referrals

1-800-392-1207 ext 7303 Transportation Subsidy Program–for approved out of province

referrals

Third Party Liability Recovery of health services when a

General Line (204)-786-7201 Manitoba resident is injured and initiates a legal or insurance

claim against a third party

Physician’s Newsletter

4 January 2015

“NEW” CLAIMS PROCESSING SOLUTION (CPS)

Manitoba Health, Healthy Living and Senior’s (MHHLS) is currently undergoing final testing and preparations

for implementation of the new Claims Processing Solution (CPS).

MHHLS continues to monitor claim submissions from physician billing systems to assess readiness and

compliance with the requirements for the new CPS. The efforts of all those who have made the required technical

changes to date is very much appreciated. The new CPS is anticipated to be operational in early 2015.

For additional information and details on the new CPS, please visit the MHHLS’ Claims Processing web page at

http://www.gov.mb.ca/health/claims

If you require assistance or have specific billing questions in relation to the new CPS, please do not hesitate to

contact the Claims Unit General Enquiry at 204-786-7355.

“NEW”THE PERSONAL HEALTH INFORMATION ACT (PHIA)

The Personal Health Information Act (PHIA) requires all health information trustees, including health care

facilities (ex: medical clinics and laboratories), health services agencies and privately practicing licensed,

registered or designated health professionals to be familiar with PHIA and to develop policies and procedures as

required by the Act.

To assist trustees in complying with the many requirements of this law, Manitoba Health, Healthy Living and

Seniors (MHHLS) has developed a PHIA Online Training Program. This program provides a comprehensive

review of The Personal Health Information Act (PHIA) and offers the following three versions free of charge:

1. Direct PHI Version–for health professionals and their staff who are required to access personal health

information in providing care and services to patients and clients;

2. Indirect PHI Version–for individuals who are not required to access personal health information in

carrying out their duties, but may have access to it, including for example custodial staff and volunteers;

and

3. Administrator Version–for office managers and IT administrators of a private professional practice who

are responsible for developing and implementing office policies and procedures.

Interested parties can register for the program as an individual or as a health information trustee organization.

Organizations can register their employees and can monitor which of their registrants have completed the training.

Individuals that complete the training receive a program completion certificate for the version that they complete.

The certificate is valid for three years.

All training versions noted above can be accessed at: http://www.trainingtodo.com/mbhealth/secure/index.asp.

In addition to the training program, revised Guidelines have been approved respecting the legislated requirement

for the creation and auditing of Records of User Activity by trustees that maintain personal health information in

an electronic information system (ex: an electronic patient record or electronic medical record).

Finally, MHHLS has developed a list of the policies and procedures required by trustees, including health

professionals in private practice, to comply with PHIA. This list and other PHIA resources are available on the

MHHLS’ website at: http://www.gov.mb.ca/health/phia/resources.html.

Please feel free to contact the Legislative Unit of Manitoba Health, Healthy Living and Seniors at 204-788-6612

or by email at PHIAinfo@gov.mb.ca with any questions or requests for further information on any of the above

noted matters.

Physician’s Newsletter

January 2015 5

CLAIMS UNIT

ELECTRONIC USER SITES—REMITTANCE DOWNLOAD INSTRUCTIONS

All electronic user sites are responsible for downloading their remittance advice twice monthly. The remittance

file corresponds to the payment dates of the 15th

of the month and the last day of the month, every month. The

first day that a remittance advice is available is 2 working days after the cut-off dates listed on the message

screen. The message screen will say which remittance advice is available at any given time for each specific user

site at logon. Even if you have not submitted for a specific pay period, check to ensure that there is not a

remittance advice to download that could contain the payment reconciliation of claims pending on previous pay

periods or adjustments based on query results.

Manitoba Health, Healthy Living and Seniors (MHHLS) receives a large number of calls regarding missed

downloads and user sites requiring recreates for multiple months. MHHLS’ policy will allow every user 1 recreate

free of charge per year. Subsequent requests will result in a $300 fee for each payment recreate requested.

If you are missing more than one remittance advice and require recreates for those pay periods, please call the

Claims Unit at 204-786-7269, 204-788-2584 or 204-786-7394 to inquire about additional recreates.

If you have any questions regarding Download specifications please review the Electronic Claims Program User

Guide available through the EPiCS system online or call our Helpdesk for specific questions at 204-786-7200. If

you are going to be away from your office for a period of time, please notify the Helpdesk in advance and

arrangements can be made to send you the remittance advice for those pay periods for reconciliation purposes

upon your return so that recreates can be avoided.

“NEW” DIAGNOSTIC CODES (ICD-9-CM)

Claims submitted to MHHLS with invalid ICD-9-CM codes after “go-live” of the new claims processing system

will show on the remittance file as unpaid with Explanation of Benefits (EOB) code “Z7”. This service was

refused as a valid ICD9 code is required.

The following list shows the most commonly received invalid codes:

Invalid ICD-9-CM Codes

V728 4273 5301 7169

2500 781 4140 V726

7890 7805 V723 3469

3000 7860 2959 7803

4939 7807 7194 5997

7159 2865 6221 3625

7865 V300 2962 5640

6621 7071 3140 1733

367 V250 7531 5308

Where can I find the list of valid ICD-9-CM codes?

The source of valid ICD-9-CM codes used by MHHLS can be found at:

http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/codes.html

Physician’s Newsletter

6 January 2015

What will happen to claims in the new claims processing system that are submitted with an invalid ICD-9-

CM code?

Claims submitted with invalid ICD-9-CM codes will show on the remittance file as unpaid with Explanation of

Benefits (EOB) code “Z7”. This service was refused as a valid ICD9 code is required. You will be required to

resubmit the claim with a valid ICD-9-CM code for the claim to be adjudicated.

Note: The claims processing system does not use “E” codes, only ICD-9-CM diagnostic codes.

Where can I find valid ICD-9-CM codes?

ICD-9-CM code books may be purchased locally or online. A link has been provided to an online source for your

reference:

https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2530043&navAction=push

A list of valid ICD-9-CM codes is also available online. A link has been provided to one online source for your

reference.

https://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/codes.html

ICD-9-CM books are available locally for purchase at:

Health Sciences BookStore (University of Manitoba)

Phone: 204-789-3601, Fax: 204-789-3901

Email: medbookstore@umanitoba.ca

Mailing Address:

140 Brodie Centre

727 McDermot Ave

Winnipeg, MB R3E 3P5

Fort Garry BookStore, General Reading & Reference, Special Orders (University of Manitoba)

Phone: 204-474-8321, Fax: 204-474-7555

Email: bookstore_webmaster@umanitoba.ca

Mailing Address:

140 University Centre

University of Manitoba

Winnipeg, MB R3T 2N2

Physician’s Newsletter

January 2015 7

INTEREST RATES–JANUARY 1, 2015

Electronic claims not paid within 30 days of receipt or paper claims not paid within 60 days of receipt, are paid

interest on the outstanding amount of the claim until the date of the actual payment. The interest is paid at the

prime lending rate plus 1%. This rate is adjusted on January 1st and July 1

st of each year.

Effective January 1, 2015 the prime lending rate was set at 3%. Claims eligible for interest will be calculated at

3% (prime rate) plus 1% for a total of 4%.

Claims that span two (2) interest periods will be paid at the current interest rate at the time of payment for the

claim. E.g. Interest owed for November, December, January and February - Calculation will be based on the rate

that is in effect for February.

DISPOSAL CODE 44

Claims which do not include sociological data that matches Manitoba Health, Healthy Living and Seniors’

(MHHLS) registration database will be automatically rejected with Disposal code “44”. The sociological data

which must match MHHLS’ registration database is:

PHIN–9 digit Personal Health Identification Number

6 digit MHHLS number

surname

given name

date of birth

sex

Claims that are rejected for incorrect sociological data should be changed and resubmitted electronically. Please

do not query.

MHHLS will continue to assist physicians in obtaining accurate sociological data on their patients, in one of two

ways.

1. Access to iREG, MHHLS’ Insurance Registry, is available to all Manitoba physicians. This application

allows the physician or billing staff to verify sociological data for their patients, prior to submitting their

claims. To apply for iREG, please call 204-786-7225 or 204-788-2584.

2. If you require information on patient eligibility, complete a 529 form Request for MHHLS’ Registration

Number. A supply of these forms may be obtained by calling 204-786-7159. The completed form may be

faxed to MHHLS at 204-783-2171, toll free at 1-866-608-2983, or mailed to 300 Carlton Street,

Winnipeg, Manitoba R3B 3M9. MHHLS’ staff will endeavor to complete/correct the data that has been

included on the form, and will thereafter fax or mail the information to you.

TIMELINE FOR SUBMISSION OF CLAIMS

Physicians and billing staff should be aware that the deadline for submission of claims to Manitoba Health,

Healthy Living and Seniors is six months from the date of service.

All physicians are encouraged to submit their claims at frequent intervals to ensure timely processing of claims.

Physician’s Newsletter

8 January 2015

CHRONIC DISEASE MANAGEMENT (CDM) TARIFFS

Submission of Patient Care Treatment Forms

Chronic Disease Management (CDM Tariffs 8431, 8433, 8434 and 8435) forms can be submitted as follows:

1. Mail: Paper copies of the completed Patient Care Treatment Forms can be mailed to the Claims Unit at 300

Carlton Street.

2. Drop off: Paper copies of the completed Patient Care Treatment Forms may be dropped off at 300 Carlton

Street.

3. Completion of the eForm: The eForms can be completed on-line and electronically submitted directly to a

secure government repository. The eForm can be found at:

http://www.gov.mb.ca/health/primarycare/chronicdisease/docs/patientcaretreatmentforms.pdf.

4. EMR data extract: General practitioners using a Manitoba-approved Electronic Medical Record (EMR)

system may have the option of submitting the supporting information through a quarterly data extract from

their EMR, rather than completing the Patient Care Treatment Form to substantiate their claim. This option

is available to PIN sites and other sites that have met the criteria for electronic submission and been informed

of this by Manitoba Health, Healthy Living and Seniors. For additional information regarding this option,

please contact Katie Dyck at (204) 926-3803 or by email at kdyck10@manitoba-ehealth.ca.

Physicians are reminded that CDM tariffs are payable only to the general practice physician who has

provided the majority of the patient’s ongoing comprehensive care, in relation to the management of the

chronic disease, for the preceding twelve (12) months.

Physician’s Newsletter

January 2015 9

MIDWIFERY REFERRALS AND PROVIDER NUMBER

Midwifery has been a regulated profession in Manitoba since June 12, 2000. Midwives have the ability to refer

their clients for lab & x-ray tests as well as consultations with Physicians.

In the past, billing number 3993 (Midwifery) was entered in the “referring doctor” field as a generic identifier on

lab & x-ray claims. The same number was used on claims billed by Physicians for services such as the Midwifery

Assessment and Report (tariff 8416) and Telephone/Facsimile/Email Communications (tariff 8000) when the

referring provider was a Midwife.

Midwives are now registered by Manitoba Health, Healthy Living and Seniors, Practitioner Registry with unique

provider numbers. The Midwife’s unique provider number should now be entered in the “referring doctor” field

for any applicable physician billing (i.e. tariff 8416, lab claims, etc.). Use of the generic billing number 3993 will

be discontinued.

LAB SERVICES FOR NORTHERN ONTARIO RESIDENTS

Manitoba Health, Healthy Living and Seniors has been advised by OHIP that effective August 1, 2013, Manitoba

physicians authorized to order lab services in Manitoba will now be able to order lab services in Ontario for

Northern Ontario patients (Kenora and surrounding areas) without requiring an Ontario physician sign the

requisition form.

All requests must be submitted on an Ontario laboratory requisition form which can be found on Ontario's website

at:

http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/GetAttachDocs/014-4422-84~1/$File/4422-84.pdf

Any questions concerning this process may be directed to Ontario at interprovincebilling.moh@ontario.ca

Physician’s Newsletter

10 January 2015

OUT-OF-PROVINCE UNIT

RECIPROCAL BILLING

Reciprocal billing agreements between the provinces (except for Quebec) allow physicians to submit claims to

Manitoba Health, Healthy Living and Seniors (MHHLS) for most services provided to out-of-province patients.

This includes services rendered in the ER, OPD or In-patient department of a hospital and in private offices

(except for certain excluded and in-hospital diagnostic services as noted below).

Therefore you should submit your accounts for insured services provided to any Canadian resident (except for

patients from Quebec) to MHHLS for processing at Manitoba rates.

Carefully check the patient’s health care card to ensure that their coverage has not expired, as some provinces

issue renewable rather than lifetime registration numbers.

If a patient does not present a valid health care card, the patient can be considered uninsured and billed directly

for all services. The patient may then seek reimbursement from their private insurer or, if they have valid

coverage, their home province’s insurance plan.

Quebec does not participate in the inter-provincial reciprocal medical billing agreements. If you treat a Quebec

resident, your physician billing options are as follows:

• Bill the Quebec resident directly. The resident can then seek reimbursement from the Quebec

Health Plan; or

• Bill the “The Régie de l'assurance maladie” (contact information can be found at

http://www.ramq.gouv.qc.ca/en/courrier/index.shtml). You will be paid the applicable Quebec

rates for the services rendered. You will also need to ensure that the Quebec resident’s health care

card is valid.

Physician’s Newsletter

January 2015 11

PRACTITIONER REGISTRY

CHANGE OF ELECTRONIC USER SITE

Practitioners changing and/or leaving an Electronic User Site should notify Manitoba Health, Healthy Living and

Seniors (MHHLS) in writing specifying the date they will be leaving practice at that location. Please be sure to

include your name, billing number, user site number and the effective date. Once this information is received,

MHHLS will adjust your profile to reflect the corrected information.

When beginning at a new practice location, practitioners should complete a Letter of Agreement form. The Letter

of Agreement allows MHHLS to link the practitioner’s billing number with the new user site number so claims

will be accepted electronically by MHHLS. Fee-for-Service practitioners should complete an Electronic Funds

Transfer form. The Electronic Funds Transfer form allows MHHLS to direct the funds generated through the

submission of claims at that location to a bank account of your choice. Claims should not be submitted before

these completed forms are sent to MHHLS.

To request forms, obtain additional information or submit correspondence regarding any of the above changes

please contact Practitioner Registry at:

Practitioner Registry

Manitoba Health, Healthy Living and Seniors

3rd

Floor, 300 Carlton Street

Winnipeg, Manitoba R3B 3M9

Phone: 204-788-2567

Fax: 204-942-2356

Email : practitionerregistry@gov.mb.ca

CHANGE OF SOFTWARE VENDOR

Practitioners changing Software Vendors must notify Manitoba Health, Healthy Living and Seniors (MHHLS) in

writing. Be sure to indicate that you are changing software vendors, include your current user number and

projected conversion dates. Please indicate that your intent is to close your old user site number once all claims

and queries have been cleared.

You will need to complete and submit several forms to MHHLS in order to apply for a new Electronic User

Number. A test submission is also required. Your new user site number will not be activated until you have

passed the testing process.

Please contact Practitioner Registry for additional details and to request the required forms:

Practitioner Registry

Manitoba Health, Healthy Living and Seniors

3rd

Floor, 300 Carlton Street

Winnipeg, MB R3B 3M9

Phone: 204-786-7225

Fax: 204-942-2356

Email : practitionerregistry@gov.mb.ca

Physician’s Newsletter

12 January 2015

CHANGE OF MAILING ADDRESS

Practitioners changing their mailing address should notify Manitoba Health, Healthy Living and Seniors of the

change in writing at least two weeks prior to moving, or leaving the province. This will allow sufficient time to

make the necessary changes; in turn ensuring future payments or correspondence is forwarded to the proper

address.

Please contact us by mail:

Practitioner Registry

Manitoba Health, Healthy Living and Seniors

3rd

Floor, 300 Carlton Street

Winnipeg, MB R3B 3M9

Email: practitionerregistry@gov.mb.ca

CHANGING OR CLOSING BANK ACCOUNT

Please notify Practitioner Registry, Manitoba Health, Healthy Living and Seniors at 204-788-2567 of all banking

changes to ensure that your financial records are updated.

IMPORTANT MESSAGE FOR MANITOBA PHYSICIANS REGARDING INSURANCE REGISTRY

(IREG) RELEASE

Pursuant to the Master Agreement between Manitoba Health, Healthy Living and Seniors & Doctors Manitoba,

we are pleased to offer iREG (Insurance Registry) access to Manitoba physicians who currently submit claims

using the EPiCS (Electronic Practitioner integrated Claim Submission) system.

The Master Agreement states the following:

12:01 The parties acknowledge and agree that Manitoba Health has committed to provide Manitoba

physicians that have EPiCS infrastructure in their office(s) with access to the Insurance Registry (“iREG”).

Implementation will commence December 1, 2011. Thereafter, Manitoba Health will release iREG access to

applicants over a six to twelve month period.

You will see an icon when logging into WebLink (EPiCS) – “iREG release package”. This is a PDF document

which contains all the necessary paperwork in order to apply for iREG.

For additional information please call the Claims Unit at 204-786-7225.

Physician’s Newsletter

January 2015 13

THIRD PARTY CLAIMS

WORKERS COMPENSATION BOARD (WCB) BILLINGS

Manitoba Health, Healthy Living and Seniors (MHHLS) has been receiving billings from physicians providing

medical services to patients who have sustained injuries or illness as a result of their employment for which they

are covered by Workers Compensation Board.

Physicians are reminded that the following services are not insured by MHHLS as set out in the Excluded

Services Regulation under The Health Services Insurance Act.

Exclusions

The following services are not insured services:

Services for any illness, injury or condition arising out of or in the course of employment and for which the

indemnity is received under workers’ compensation law, occupational disease law or similar legislation.

In those instances where the physician is treating a patient for a work-related injury or illness, but is not certain of

WCB liability, it is recommended that the initial billing be made to WCB.

Should the Board deny responsibility for the case, the claim may be redirected to MHHLS with a notation

indicating WCB rejection.

In cases where a WCB claim has been paid by MHHLS and subsequently paid by WCB, the request to withdraw

MHHLS’ payment must be submitted via query form.

Physician’s Newsletter

14 January 2015

PHYSICIAN’S MANUAL UPDATES

Updates to the Physician’s Manual are available on the Manitoba Health, Healthy Living and Seniors’ website for

viewing and downloading.

Visit the site at www.gov.mb.ca/health/manual

The site will be updated quarterly, January 1st, April 1

st, July 1

st and October 1

st of each year.

Comments or questions about the manual may be directed to manual@gov.mb.ca

Physician’s Newsletter

January 2015 15

APPEND IX

IMPORTANT DATES FOR 2015

HOLIDAY CLOSURES

Manitoba Health, Healthy Living and Seniors’ offices will be closed on the following dates:

• January 1, 2015

• February 16, 2015

• April 3, 2015

• April 6, 2015

• May 18, 2015

• July 1, 2015

• August 3 , 2015

• September 7, 2015

• October 12, 2015

• November 11, 2015

• December 25, 2015

• December 28, 2015

Physician’s Newsletter

16 January 2015

MANITOBA HEALTH, HEALTHY LIVING AND SENIORS 2015 CUT-OFF DATES FOR

ELECTRONIC CLAIMS

PAY PERIODS EPiCS

JANUARY 14

30

8

26

FEBRUARY 13

27

9

23

MARCH 13

30

9

24

APRIL 14

29

8

23

MAY 14

29

8

25

JUNE 12

29

8

23

JULY 14

30

8

24

AUGUST 14

28

10

24

SEPTEMBER 14

29

8

23

OCTOBER 14

30

7

26

NOVEMBER 13

27

6

23

DECEMBER 14

30

8

22

EPiCS cut-offs are at 5:00 P.M. Check the message screen in case of changes.

Manitoba Health, Healthy Living and Seniors strongly recommends you submit claims frequently (no less than

once per week) to reduce your risk of missing a payment cycle.

Always check the audit control confirmation report (P1) the next business day to verify acceptance of files.

Acceptance of the file does not guarantee payment for the claims submitted as all claims received must still

follow normal processing channels and rules. Questions or concerns? Please contact: ELECTRONIC SUPPORT

at 204-786-7200.

Physician’s Newsletter

January 2015 17

Physician’s Newsletter

18 January 2015

Physician’s Newsletter

January 2015 19