Claim Manager

If you need to submit or re-submit an MSP claim after 90 days since the service date, submit the claim with a special submission code: A, X or C.



How to select the submission code:



(1) Code A.

If you want to re-submit a claim that was declined due to a procedural (code BV, e.g.) or clerical error (wrong patient’s name, for example) or if you bill for the service first time, get an MSP approval for your late claim first. After you receive the approval, submit the claim with code ‘A’. To get an approval, fax the form HLTH 2943 to (f) 1 (250) 405-3593. The form must be submitted within 6 months from the date of service.



(2) Code X.

If you want MSP to change its decision on your declined claim, re-submit it with code ‘X’ and a note, explaining your appeal. Form HLTH 2943 is not required.  The claim must be re-submitted within 90 days from original remittance.



(3) Code C. f you want to re-submit a claim for a patient who did not have active MSP coverage on the date of service but the coverage was retroactively reinstated, re-submit claim with code ‘C’. Add a note ‘Coverage re-instated’. Form HLTH 2943 is not required.

Q. What happens if I submit an over-age MSP claim before getting an approval?



A. Your claims will be rejected with code BV “Service date exceeds allowable claim submission period.”



Q. Do I need to use codes A, X or C for over-age WorkSafeBC or ICBC claims.



A. No. These codes apply only to MSP claims. Over-age WorkSafeBC and ICBC claims are submitted with codes ‘W’ and ‘I’ accordingly.



Q. How much time do I have to submit form HLTH 2943 for late MSP claims?



A. Submit form HLTH 2943 no later than six months after the date of service. Only in very exceptional circumstances will claims be approved retrospectively up to 18 months. No claims will be approved beyond 18 months ago.



Q. I got my form HLTH 2943 approved. Does it mean that my late claims will be paid?



A. Not necessarily. All claims billed are subject to the usual processing and adjudication rules and regulations. The approval of the form only means that your claims will be not be declined with code BV “Service date exceeds allowable claim submission period.”

Q. I billed my patient privately because his did not have MSP coverage on the date of service. His coverage was re-instated retroactively after the 90 days has passed. Do I need to use code ‘C’ if I want to re-bill the service to MSP? This is going to be my first submission for the service.



A. Yes, you can use code C for claims that are late both originally and in re-submission.



Q. Do I need to add a note ‘Coverage reinstated’ to the claim with ‘C’ code?



A. If you don’t do it, Claim Manager will add the note for you.



Q. Do I need to use code ‘C’ for over-age WorkSafeBC or ICBC claims?



A. No.

Q. I want to re-submit a declined claim. I am not sure if I need to use code ‘A’ or ‘X’?



A. Consider the reason for your claim being declined. Was it declined because you made a data entry error? Then re-submit with code ‘A’. If MSP does not believe that you are entitled to the payment and you disagree, re-submit with code ‘X’ and a note.



Q. My claim was declined with code BV “Service date exceeds allowable claim submission period.” What code do I use to resubmit it?



A. Use code ‘A’.



Q. How much time do I have to resubmit claim with code X?



A. Claims with code X must be resubmitted within 90 days of the remittance date of the original claim.

Fill in HLTH 2943 only when you need to submit late MSP claim with submission code A.



Section 1: Practitioner Information.



• Enter the treating practitioner’s information.




• Enter the practitioner’s MSP number if the payment goes to the practitioner; enter a different payment number if payment goes to another entity (clinic or another practitioner, e.g.).



Section 2: Claim Information.



• If submitting request for only one claim, enter the date of service into the “Date of Service” field. Ignore “Date Ranges” fields.




• If submitting request for a group of claims, enter the service date of the earliest claim into the “Date Ranges: From” field. Enter the service date of the latest claim into the “Date Ranges: To” field. The date range is indicated across all patients if the request is made for multiple patients.




• Enter approximate number and dollar value of claims across all patients into the corresponding fields. List all fee items in the “Fee Item(s) involved.”




• Enter explanation for late submission of claims. Administrative issues such as staffing problems, clerical errors, lost or forgotten claims, system or service bureau problems might not qualify for exemption.




• If submitting over five claims, select any five claims and enter the personal health numbers, date of service and fee items in the verification section. If request is for five or less claims, enter all over-the age claims in the verification section.





How to submit HLTH 2943





1. Print, date and sign.
2. 
Fax this form to the MSP Teleplan billing support at (250) 405-3593.





Submit late ICBC claims with code I. No Form HLTH 2943 “Practitioner Request for Approval of Over-Age Claims” is required for ICBC claims. The claims must be resubmitted within 90 days from the remittance date of the original claims.

Submit late WorkSafeBC claims with code W. No Form HLTH 2943 “Practitioner Request for Approval of Over-Age Claims” is required. The claims must be re-submitted within 90 days from the remittance date of the original claims.

• ‘A’: submission of over-age MSP claim. A written pre-approval is requested from MSP (form HLTH 2943). This claim must match a pre-authorized record created by MSP claims staff.
• ‘X’: -re-submission of over-age MSP claims that was refused or partially-paid during adjudication; a Note is required.
• ‘C’: Subscriber coverage problem; a Note record (N01) is required
• ‘W’: Over-age WorkSafeBC claim submitted/re-submitted to WorkSafeBC or re-billed to MSP if MSP is determined to be the payee.  If you re-submitted the claim to WorkSafeBC it also has to include ‘WC’ in the insurer field P100.
• ‘I’: Over-age ICBC claims. All ICBC claims also have to include ICBC Claim number if known and set MVA field indicator to ‘Y’.





Claim Manager analyzes all over-age Teleplan claims and prompts the practitioners to use the appropriate over-age code if required.

• (p) 1 866 456-6950
• (p) 604 456-6950
• (f) 250 405-3593
• Mailing Address: Medical Services Plan, PO Box 9480, STN PROV GOVT, Victoria BC, V8N 9E7