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Ontario Health Insurance Plan

OHIP Bulletins


INFOBulletin

Keeping Health Care Providers informed of payment, policy or program changes

Primary Health Care Services InfoBulletins

To:  Eligible Patient Enrolment Model Physicians

Published by:  Negotiations Branch

Date Issued:  March 7, 2017

Bulletin Number:  11170

Re:  New Patient De-Rostering Process

Posted Electronically Only

PDF Version Portable Document Format | 147 Kb


Effective February 1, 2017, the ministry is introducing a new patient de-rostering process for physicians in all Patient Enrolment Models (PEM).

Under the new process, physicians will no longer be required to batch and submit paper copies of the "Primary Care – Request to Remove a Patient" form to the ministry.

Any forms submitted to the ministry after April 1, 2017 will not be processed or returned to your office but will be securely destroyed.

Patients will be de-rostered and enrolment records will be updated through the submission of a Per Patient De-Rostering (PPDR) tracking code.

Per Patient De-Rostering (PPDR) Q Codes

To de-roster a patient, physicians must submit one of the following PPDR Q codes:

  • Q401A – De-Roster – Member Deceased
  • Q402A – De-Roster – Ended by Provider
  • Q403A – De-Roster – Patient Left Province

Billing Rules for PPDR Q Codes

  • Physicians may submit a PPDR Q code with a service date six months prior to February 1, 2017 based on the six month stale date rules.
  • PPDR Q codes submitted with a service date prior to August 1, 2016 will reject A3E – No Such Fee Schedule Code.
  • PPDR Q codes may be submitted to de-roster any enrolled patients.
  • The service date on the claim will be the end date on the ministry's enrolment system.
  • These PPDR Q Codes will be processed and paid at $0 with explanatory code 30 – This service is not a benefit of OHIP.
  • PPDR Q Codes may be submitted separately or in combination with other fee schedule codes.
  • PPDR Q Codes are subject to regular claims processing rules (i.e. stale-dating).

To ensure your patients have been successfully de-rostered, please review your "Roster and Capitation Payment Reconciliation Report" each month to ensure the patient's end date and applicable termination code appear on the report.

If your patient's end date does not appear on the report, verify your claims error reports and make any corrections needed before resubmitting.

If there is no reject for the patient's PPDR Q Code then resubmit the appropriate PPDR Q code.

Forms previously submitted with an end date prior to August 1, 2016

Physicians who have submitted a "Primary Care – Request to Remove a Patient" form with a requested end date prior to August 1, 2016 must wait to have their form processed.

Forms previously submitted with an end date after August 1, 2016

Physicians, who have submitted a "Primary Care – Request to Remove a Patient" form with a requested end date after August 1, 2016, and within the 6 month claim submission window, may now submit a PPDR Q Code or wait for the form to be processed.

Physicians wishing to de-roster a patient with a service date after August 1, 2016, but where the service date of the claim is greater than 6 months from the claim submission date must contact their Claims Services Branch (CSB) office and request approval to submit a stale dated claims file for these claims. Approval must be received prior to submitting the stale dated claims file.

For any inquiries regarding the PPDR claims submission or patient de-rostering process please contact the Service Support Contact Centre at: 1-800-262-6524 or SSContactCentre.MOH@ontario.ca.

Other

Physicians are reminded that patients may continue to de-roster themselves by contacting the Service Ontario INFOline at 1-800-267-8097.

Physicians requiring information on how to enroll a patient can find further details in INFOBulletin – 11055, INFOBulletin – 11056 or INFOBulletin – 11057 issued in January 2013.


To view Portable Document Format PDF files, you will need to have Adobe Acrobat® Reader installed on your computer. You can download this free software from the Adobe website.

For More Information

Call ServiceOntario, Infoline at:
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In Toronto, (416) 314-5518
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282
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