Ontario Health Insurance Plan

INFOBulletin

Claims Adjustment for Fee Codes Allowed with K094A/K095A

Previously submitted applicable fee schedule codes will be adjusted

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To: All Providers
Category: Physician Services
Written by: Claims Services Branch, OHIP, Pharmaceuticals and Devices Division
Date issued: December 22, 2021
Bulletin Number: 211222

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Background

Further to INFOBulletin # 211101 – COVID-19 Temporary Palliative Virtual Care Service Changes, analysis has been completed to determine the claims requiring adjustment for the additional fee schedule codes (FSCs) being allowed with K094A (Virtual Palliative Care Support-Telephone) and K095A (Virtual Palliative Care Support-Video).

The impacted claims have service dates on or between March 14, 2021 and October 31, 2021 and were previously submitted with one of the following services on the same claim or on history with either K094A or K095A:

• G512A: Weekly Palliative Care Case Management Fee
• K002A: Interviews with Relatives on Behalf of a Patient
• K015A: Counselling of Relative on Behalf of a Patient
• K070A: Home Care Application
• K121A: Hospital In-Patient Case Conference
• K124A: Long-Term Care/CCAC Case Conference
• K700A: Palliative Care Out-Patient Case Conference
• K705A: Long-Term Care-High Risk Patient Conference

Claims Processing

1. The codes listed above have been paying correctly since November 1, 2021, because of the implementation of a new payment rule in the claims payment system. These items were originally paid at $0 with an explanatory code of ‘D7 – Not allowed in addition to other procedure’.
2. Claims submitted prior to November 1, 2021 with any of the above codes (including K094A and K095A for the time-period above) will be adjusted to pay in accordance with the new payment rule.
3. These adjustments will begin to appear on the January 2022 Remittance Advice (RA) and may report over several RA’s.
4. Reprocessed claims will appear on the RA with explanatory codes ’55 – This deduction is an adjustment on an earlier account’ and ’57– This payment is an adjustment on an earlier account’.

Keywords/Tags

OHIP; Physicians; COVID-19; Palliative; Virtual; K094A; K095A

Contact Information

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

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