Ontario Health Insurance Plan
OHIP Bulletins
INFOBulletin
Keeping Health Care Providers informed of payment, policy or program changes
To: Providers
Published by: Claims Services Branch, Ministry of Health
Date Issued: April 3, 2020
Bulletin Number: 4752
Re: Medical Claims Adjustment – Arthroscopic Knee Surgery
Posted Electronically Only
Claims Submissions
Due to the staged implementation of new system processes, a Medical Claims Adjustment (MADJ) for Arthroscopic Knee Surgery is required to reprocess claims for the following fee service codes: E476, E478, E489, E491, E492, E493, E494, E495, E496, E498 (new), R687, and R699 (new).
- Claims submitted for Arthroscopic Knee Surgery between October 1 and October 31, 2019, for service dates in October 2019 that were previously paid on the November 2019 Remittance Advice will be subject to a MADJ. If necessary, these claims will be adjusted in accordance with the changes to the Schedule of Benefits for Physician Services effective October 1, 2019.
- Adjustments will begin to appear on the April 2020 Remittance Advice.
- Please also note that during the MADJ process, the claims processing system selects an entire claim and reprocesses it. A single claim can include multiple fee schedule codes and all codes will be reprocessed. Claims that were reprocessed with no change in payment will appear on the Remittance Advice (RA) with explanatory code '55 – This deduction is an adjustment on an earlier account' and '57 – This payment is an adjustment on an earlier account'. These two transactions will net out to zero with no payment impact but will report on the RA for reconciliation purposes.
For further details relating to Arthroscopic Knee Surgery, please refer to INFOBulletin #4737.
For any further inquiries, please contact the Service Support Contact Centre at 1-800-262-6524.
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