Ontario Health Insurance Plan

INFOBulletin

New Specialty in Critical Care Medicine

A new Ontario Health Insurance Plan (OHIP) billing specialty designation in Critical Care Medicine has been created.


To: Physicians
Category: Physician Services
Written by: Health Services Branch, Ontario Health Insurance Plan Division
Date issued: January 14, 2021
Bulletin Number: 210105


New Critical Care Medicine OHIP Billing Specialty

Following consultation with the Ontario Medical Association (OMA), the Ministry of Health (ministry) has created a new billing specialty designation under the Ontario Health Insurance Plan (OHIP) for Critical Care Medicine, effective January 1, 2021.

Billing specialties are assigned by the ministry when physicians register for a billing number and must be used when submitting claims. In order to be assigned a billing specialty, the physician must have the appropriate specialty or sub-specialty, as recognized by the College of Physicians and Surgeons of Ontario (CPSO).

The new OHIP billing specialty designation for Critical Care Medicine has been assigned number “11” in the OHIP claims system.

Eligibility

In order to obtain the Critical Care Medicine billing specialty, the physician must have a sub-specialty in Critical Care Medicine as recognized by the CPSO.

In order to obtain the CPSO subspecialty, a physician must hold a Critical Care Medicine sub-specialty certification from the Royal College of Physicians and Surgeons of Canada (RCPSC).

If a physician does not hold the RCPSC sub-specialty certification but believes they are eligible, they should contact the CPSO directly in order to assess their eligibility.

Registration Process

The Critical Care Medicine billing specialty is effective as of January 1, 2021, and registrations can be backdated to January 1, 2021 or the effective date of the physician’s CPSO sub-specialty in Critical Care Medicine, whichever is later.

In order to register for the new OHIP billing specialty designation in Critical Care Medicine, please send an email to the ministry’s Provider Registration Services Unit at ProviderRegistration.MOH@ontario.ca.

The email must clearly state that the “Critical Care Medicine” billing specialty designation is being requested as of a specified date on or after January 1, 2021. The email must also provide the physician’s current OHIP billing number and CPSO number.

The ministry will verify the physician’s registration with the CPSO and verify that the physician has a sub-specialty in Critical Care Medicine as recognized by the CPSO. Following completion of this verification process, the ministry will notify the physician by email that the registration is complete and the Critical Care Medicine billing specialty (11) has been assigned. The registration date will also be noted in the ministry’s email sent back to the physician.

The new billing specialty can also be requested by calling the ministry’s Service Support Contact Centre (SSCC) at 1-800-262-6524.

Submitting Claims

Once the registration process is complete and a physician has been assigned the Critical Care Medicine billing specialty designation in the OHIP claims system, the physician can begin submitting claims using their new designation. Please note that even with backdating registration, the ministry’s existing stale-date policy still applies. Physicians have 6 months from the service date to submit claims.

A physician can hold more than one billing specialty, but each claim can only be submitted with one billing specialty. When submitting claims, the physician must indicate on each claim which eligible billing specialty designation applies, as appropriate based on the applicable insured service(s) on the claim(s).

Currently in the Schedule of Benefits for Physician Services there is no ‘Consultation and Visits’ general listings for Critical Care Medicine and the new “11” billing specialty can only be used to submit claims for fee codes that are not restricted to other billing specialties (example: the “11” critical care medicine billing specialty cannot be used to submit claims for fee codes restricted to the “13” billing specialty for internal medicine).

As such, when submitting claims for consultations and assessments, physicians should use their other billing specialty code(s) and the corresponding fee codes, as appropriate (example: “13” for Internal Medicine and the A135 Internal Medicine Consultation). For any other fee code that is able to be claimed by the Family Practice and Practice in General “00” billing specialty, or that is otherwise unrestricted, which includes the critical care fee codes under the Diagnostic and Therapeutic Procedures section of the Schedule of Benefits for Physician Services (beginning on Page J28), these could be claimed using the “11” billing specialty code.

Any claim submitted with the new “11” billing specialty designation must have a service date after the registration date noted in the email to the physician from the ministry. Claims submitted with billing specialty “11” prior to the physician being assigned the billing specialty by the ministry will reject with error code ‘A4D-Ineligible Specialty’. Claims submitted with billing specialty “11” and a service date prior to January 1, 2021 will also reject with the same error code ‘A4D-Ineligible Specialty’.

Keywords/Tags

OHIP; Billing Specialty; Critical Care Medicine; Specialty Code

Contact Information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.

Find INFOBulletins online on the Ministry of Health website.

 

For More Information

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