Page 2 of 6: Claims submission changes effective April 1

 Physicians and their staff are reminded that the Ministry of Health is changing the in-province insured and related services claims submission period from six to three months, effective April 1, 2023, for services rendered on or after April 1, 2023.

This claims submission timeframe adjustment is outlined in the 2021 Physician Services Agreement. The MOH is implementing similar changes for claims submissions from patients, other health practitioners, community laboratories and independent health facilities.

The ministry's current process for reviewing stale-dated claims is also being updated. Physicians currently have six months to submit billings, including any corrections to errors that appear on the error report. These errors are commonly outside the control of physicians, such as patients who don't have accurate health card numbers or version codes.

Under the PSA, also effective April 1, physicians will have unlimited time to submit the corrections, so long as they initially submit their billings within three months of the date of service. Therefore, physicians will be able to get paid for services they rendered if it takes longer than six months to get the updated patient data.

The ministry also agreed that the submission period for remittance advice inquiries will be changed from four to seven months from the date of the remittance advice, helping maintain the status quo for adjudication of these claims.