Billing and Reconciliation (Admin Workflow)

Background
Billing Submission
  Prepare Claims for Submission to MSP
  Submit Claims to MSP
  MSP Eligibility
  GPSC Portal Fake Client
  Troubleshoot Billing Submission Issues
      Diagnosis 1 field cannot be empty
      Reference 2 in alias MSP is not valid
      Alias MSP for referrer clinician is not found
      Billing Claim Created for Away Clinician instead of Covering Clinician
Billing Reconciliation
  View Reconciliation List
  Resubmit a Claim
  Write Off a Claim
  Accept or Reverse a Claim

Cleaning Up Unprocessed Claims

Resources
Related Help Files

Background

MSP billing can be done either on paper, outside of the EMR, or directly within the EMR. To submit billing in the EMR, there are responsibilities for the physician/NP and CSC.

Physician/NP responsibility

• Must have at least one ICD9 dx code in the claim
• Note: SHX and YCC codes are not accepted in the Diagnosis field

CSC responsibility

• Check and update that each claim
• Has a PHN
• Has a billing code (service code)

NOTE: There are exceptions such as WCBC and ICBC claims.

For further information on how physicians/NPs create a claim, see the  Help File : Billing and Encounter/Shadow Billing 

Billing Submission

Prepare Claims for Submission to MSP

Once the physician/NP has created the claim in the EMR, it requires the CSC to submit it to MSP.

The MSP deadline is 90 days from the date of service. If claims are not submitted within the 90-day deadline, they are considered overage and may come back as a refused claim in the Reconciliations module. Contact MSP Teleplan if you miss the MSP deadline for options.

When billing clerks are preparing to submit the clinicians' claims to MSP, it is important to note the MSP-designated holidays and close-off dates as they impact claims submission. Designated holidays impact certain claims such as the Out-of-Office Hours Premiums fee items while close-off dates are the designated semi-monthly cut-offs for claims submission through Teleplan. Claims should be submitted by close-off dates in order to be processed on the next remittance statement. See MSP Teleplan Designated Holidays and Close-Off Dates.

1. Click on Financial

a. Select Billing from the drop-down menu.

 

2. A list of claims will appear in the Billing window. Claims will either have a green check-mark or red X’s.
Those with red X’s require further information.

a. Highlight the claim
b. Note the message at the bottom of the form (eg. Diagnosis 1 field cannot be empty)
c. If you do not have all the information required to submit a claim, you must speak with the clinician who entered the claim.

 

Submit Claims to MSP

Those with green check-marks are ready to be submitted to MSP

a. Highlight the claim
b. Confirm the claim information is correct
c. Once complete, click Process to send the claim to MSP. Once sent, the claim will disappear from the list.

MSP Eligibility

To check for real-time MSP eligibility, while client is in context, click on the Real time patient verification icon. The same icon is also in Work Centre > Appointments.

GPSC Portal Fake Client

A fake client is available for GPSC Community Longitudinal Family Physician Payment annual enrollment.

PHN: 9753035697
Patient surname: Portal
First name: GPSC
Date of birth: January 1, 2013

Troubleshoot Billing Submission Issues

If your claim is missing any information or needs to be corrected, it will appear in an error message at the bottom of your form. Common error messages are covered below.

Diagnosis 1 field cannot be empty.

• The clinician needs to add at least one diagnosis (ICD-9 code) to the claim

Reference 2 in alias MSP is not valid.

• This indicates that the clinician’s MSP ID or Payee ID for the billing POS is incorrect or not entered in the EMR.
• Email [e-mail] with the billing clinician's MSP ID and Payee ID with billing POS Code

Alias MSP for referrer clinician is not found.

• Referral source does not have MSP ID. If not required by the billing code, delete the Referral Source from the billing claim. Example of billing code that requires Referral source is No Charge Referrals
  (billing code 3333).

Billing Claim Created for Away Clinician instead of Covering Clinician

When billing claims are being created automatically upon Arrival of a booked appt, the billing claims are being created for the clinician the appt is booked for despite the use of the Covers For functionality. To prevent this, it is recommended to create the Covering Clinician their own appt column and then move the away clinician's appts over (see Manage Appointments).

Billing Reconciliation

In certain circumstances, MSP may pay, reject, reduce or refuse payment on a claim submitted by a health care practitioner. In each case, explanatory codes accompany the payment, rejection, reduction or refusal in order to provide the practitioner with the reason for their claim not being paid in full. See MSP Teleplan Explanatory Codes

The billing clerk should review the Reconciliation list to correct and resubmit, accept, or write-off claims.

View Reconciliation List

1. Click on Financial

     a. Select Reconciliation from the drop-down menu.

 

2. Reconciliation window opens

    a. Click the Receive button to pull the latest data from MSP Teleplan
    b. The View filter defaults to: Pending at Current POS (C12 Messages Only, Not Resubmitted) (All Cycles). This filter only displays reconciliations with a C12 message. Refusal claim record C12 indicates when a claim is refused due to format, edit, or eligibility error conditions (e.g. verification of data center#, payee ID, provider MSP#, diagnosis, service code, patient PHN).

To view other Remittance Record Types such as S02 (Paid with an Explanation) and S04 (In Hold Process), you will need to change the view filter to: Pending at Current POS (All Massages) (Latest Cycle). 

To view complete records that have no outstanding amount, use the view filter: Complete at Current POS (All Massages) (Lates Cycle)

    c. To view a claim, select it from list by clicking to highlight it

          i. The Remittance Details will sit on the far right side of the screen with Explanations on how                   the claim was processed (eg. Practitioner number is invalid).

         ii. There is an Explanations tab at the top of the Reconciliation screen with definitions for each                code (e.g., AB – PHN is not on our records). Refer to the MSP website for further explanations                on each definition.

Resubmit a Claim

Resubmitting a claim journals away the previous invoice and creates a new claim to be process in the Billing view.

1. Highlight the claim
2. Correct any outstanding issues (see Explanations in the Remittance Details tab)
3. Click the Resubmit button

Write Off a Claim

Writing off a claim journals the invoice and completes the process (with no payment or encounter reporting).

1. Highlight the claim
2. Click the Write Off button

Note: For write-offs, refer to your clinic’s processes on when to write-off a claim.

Accept or Reverse a Claim

Note: You may need to change view filter to Current Clinic - Pending (Latest Cycle) to view reconciliations for acceptance or reversal.

Accepting a claim journals away any outstanding amounts (the payment has already been processed).

Reversing a claim reverses the transaction.

1. Highlight the claim
2. Click the Accept or Reverse button

Cleaning Up Unprocessed Claims

From the Billing screen, in Profile EMR version 9, you can select multiple rows using SHIFT or CTRL key from your keyboard. Here's how:

1. Select the first row, then hold SHIFT (or CTRL) key
2. Select the last row, and all rows between and including the first and last row will be selected
3. Click the Remove button
4. Click Yes to delete the selected lines

Resources

The Teleplan Support Centre handles questions about both Teleplan and the Claims Processing System, including:

• electronic billing problems
• electronic remittance statements and refusals
• MSP-practitioner-vendor liaison
• "zapping" claims submitted with incorrect data
• resetting revoked passwords, and hardware and software problems.

For questions about Teleplan and the Claims Processing System, contact the Teleplan Support Centre.

By Phone, for practitioner assistance and inquiries.

• Vancouver: [phone]
• Elsewhere in B.C.: 1-866-456-6950

Related Help Files

Shadow Billing (Help File)
MSP Website – MOA Guide to Billing
Print Appointment List for Billing