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INFOBulletin

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

Physiotherapy Facilities InfoBulletins

To: Physiotherapy Facilities

Published by: Claims Services Branch

Date Issued: May 17, 2017

Bulletin Number: 3136

Updated - Guidelines for Physiotherapy Service Encounter Submissions

Posted Electronically Only

PDF Version Portable Document Format | 141 kb


This INFOBulletin replaces INFOBulletin 3112 - Guidelines for Physiotherapy Service Encounter Submissions, dated February 3, 2015.

The following is being provided for information and reference purposes.

Before submitting service encounter codes to the ministry you must ensure your Medical Claims - Electronic Data Transmission (MC EDT) registration has been completed. If you have not completed your registration please refer to the detailed step by step guide in the MC EDT Reference Manual and Procedure Summaries at the following link: http://www.health.gov.on.ca/en/pro/publications/ohip/mcedt_mn.aspx

Note: As of December 31, 2014 MC EDT registration is mandatory.

Some of the Reports available to you from the ministry are listed below. Files will be available to download for up to twelve (12) months from the date of creation. Files can be downloaded multiple times during this period. For more details on how to access and download these reports, please refer to the MC EDT Reference Manual at the following link: http://www.health.gov.on.ca/en/pro/publications/ohip/docs/mc_edt_reference_manual.pdf

Please note that a Service Encounter submission has the same meaning as a claims submission and that service encounters may be referenced as claims in manuals or reports generated by the MC EDT system. An episode of care (EOC) includes multiple Service Encounter submissions.

File Reject Report

  • This report is usually available for download within a few hours of the service encounter file submission.
  • This report notifies you that the ministry has rejected an entire service encounter submission file. This means the file has been transferred correctly but the file does not meet current ministry technical specifications.
  • No service encounter codes included in this submission will be processed by the ministry and the file must be corrected and resubmitted.

Batch Edit Report

  • This report is usually available for download within 24 hours of the service encounter file submission.
  • If service encounters are uploaded on a weekend, holiday or at month-end, the Batch Edit Report will be available on the next service encounter processing day.
  • This is your receipt that the ministry received your file; however, it does not guarantee approval of the submitted service encounters.

Error Report

  • This report is usually available for download within 48 hours of a service encounter file submission. If service encounters are uploaded on a weekend, holiday or at month-end, the Error Report is delivered at the end of the next service encounter processing day.
  • This report provides a list of rejected service encounters and the appropriate error code(s) for each service encounter.
  • Error code descriptions and the reason for the reject can be found in section 6.4 of the Technical Specifications Manual at the following address: http://www.health.gov.on.ca/en/pro/publications/ohip/docs/techspec_interface_hcsm.pdf
  • Rejected service encounters reported on your error report must be corrected and resubmitted to the ministry within three months of the date of service. Refer to the Reporting Requirements Guide for more information regarding service encounter submissions.

Remittance Advice (RA) Report

  • The remittance advice is a monthly statement of approved service encounters.
  • It is usually available for download within the first week of the month.
  • Approved service encounters listed on the RA should be verified against your service encounter file submissions.
  • If service encounters were submitted but do not appear on your remittance advice you should review your error reports for rejected service encounters or batch edit reports for rejected files.
  • Rejected service encounters or files should be corrected and resubmitted within three (3) months of the date of service.

Cut-Off Date for MC EDT Service Encounter Submissions

The ministry operates on a monthly processing cycle. Submissions received by the 18th of the month will typically be processed for approval the following month. When the 18th falls on a weekend or holiday, the deadline will be extended to the next business day. MC EDT submissions received after the 18th may not be approved until the next monthly processing cycle. (i.e. submissions received on Nov 18th will appear on the December RA, submissions received after Nov 18th may not appear until the January RA).

Service Encounter Submissions

All service encounters rendered for each patient must be submitted to the ministry using the appropriate fee schedule code for reporting purposes (i.e. each time a patient is seen in your clinic this must be reported). Service encounter reporting is not limited to discharges (V842A or V850A). Please refer to Schedule E amended April 1, 2017, of your agreement or the Reporting Requirements Guide for a complete listing of Service Encounter Codes and Physiotherapy Diagnostic Codes to be used for service encounter submissions.

Reconciliation

Reconciliation of service encounters is the clinic's responsibility. It is recommended that all reports provided by the ministry be reviewed on a regular basis. This will ensure that any discrepancy in the number of service encounters submitted vs the number of service encounters approved by the ministry can be resubmitted in a timely manner. Service Encounters must be submitted within three months of the date of service. A review of each clinic's service encounter submissions will be conducted yearly using the information provided in the D4 Settlement Report.

Year-end reconciliations will be based on service encounter submissions received and approved on the ministry's MC EDT system.

Contacts

Inquiries related to MC EDT submissions are to be directed to the Service Support Contact Centre at 1-800-262-6524. The desk is staffed from 8:00 am until 5:00 pm, Monday to Friday, and your inquiry will be escalated to appropriate ministry staff. After business hours an answering service is available and your call will be returned the following business day.

Contact your software vendor for questions or issues related to your billing software.


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