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

To: Eligible Patient Enrolment Model (PEM) Physicians, Comprehensive Care Model (CCM), Family Health Group (FHG), Family Health Network (FHN), Family Health Organization (FHO), Blended Salary Model (BSM), Group Health Centre (GHC), St. Joseph's Health Centre (SJHC), Weeneebayko Area Health Authority (WAHA), Rural and Northern Physicians Group Agreement (RNPGA), GP Focus HIV (HIV)
Published by: Negotiations Branch, Ministry of Health
Date Issued: March 31, 2020

Physicians may now submit for their 2019/2020 Cumulative Preventive Care Bonuses. The ministry has provided all Patient Enrolment Models (PEMs) with the following information to assist with the calculation and submission of their Cumulative Preventive Care Bonuses:

Please note that Family Health Group (FHG) and Comprehensive Care Model (CCM) physicians who did not meet the minimum roster size will receive a Target Population Service Report with projected patient information for the 2020/2021 fiscal year.

Changes to colorectal cancer screening

Effective December 24, 2019, the following Fee Schedule Codes will no longer be Applicable Services for the Colorectal Cancer Screening bonus category.

  • G004A - Occult Blood
  • L181A - Occult Blood

The TPSR Previous Report and the TPSR Projected Report will continue to report these services where the service date is prior to December 24, 2019, and the service was received by an enrolled patient in the 30 months prior to March 31st of the fiscal year for which the bonus is being claimed.

Changes to pap smear codes

The list of Applicable Services for the Pap Smear Cancer Screening Bonus category is changing effective April 1, 2020. L733A - Cervicovaginal specimen is being added to the list of Applicable Services and L643A - Smear only, Gram or Papanicolaou stain as sole procedure is being removed from the list of Applicable Services.

The TPSR Previous Report will continue to report both services where the date that the service was received by an enrolled patient is in the 42-month period prior to April 1, 2020.

The TPSR Projected Report will continue to report both services where the date that the service was received by an enrolled patient is in the 30-month period prior to prior to April 1, 2020.

Where to find your roster size

The Roster Capitation Reconciliation Report included in the monthly reporting to FHG and CCM providers via Medical Claims Electronic Data Transfer includes a count of "previous month - total patients" and the "current month - total patients".

Medical Claims Electronic Data Transfer

As outlined in INFOBulletin # 11192, all providers will receive their Target Population/Service Report electronically via Medical Claims Electronic Data Transfer (MCEDT) to their Solo accounts. If you have not yet registered your solo billing number for MCEDT you will need to do so to receive this report.

Claims submission for eligible physicians

As regular stale-dating rules will apply, please ensure your bonus claims are submitted prior to the claims processing cut-off date in September 2020. Refer to the Information and Procedures for Claiming the Cumulative Preventive Care Bonus document, section 6.4 Submission Deadlines. Only claims for these five (5) bonus categories received on or prior to the cut-off date are guaranteed to be processed for payment.

Physicians who have changed billing software need to ensure they can submit Preventive Care Bonus claims without a health number, version code or date of birth. If your software does not allow for this submission, please contact your software vendor for an update.

Please note that eligible physicians should submit bonus claims using the normal billing practices used to submit Fee for Service claims. Details for submitting bonus claims are included in the enclosed Information and Procedures for Claiming the Cumulative Preventive Care Bonus document.

The Information and Procedures for Claiming the Cumulative Preventive Care Bonus document is posted on the Ministry of Health website.