To: Family Health Organization physicians
Category: Primary Health Care Services
Written by: Physician Relations & Contract Oversight Branch
Date issued: January 2, 2024
Bulletin Number: 240102

Background

Further to INFOBulletin #221203, the Ministry of Health and the Ontario Medical Association have agreed to the following implementation changes related to the Family Health Organization (FHO) primary care model.

As described in INFOBulletin #231104, claim adjustments to previously submitted claims have been processed and will begin to be reflected on the January 2024 Remittance Advice.

Update: medical claims adjustments

Claims for the services listed below submitted prior to November 1, 2023, have been adjusted to reflect that as of December 1, 2022, they will no longer be included in the basket of core services for the Family Health Organization.

• A010A – GP focused practice consultation by video
• A011A – GP focused practice repeat consultation by video
• A906A – GP focused practice limited consultation by video
• A913A – GP focused practice special consultation by video
• A914A – GP focused practice comprehensive consultation by video
• A814A – Midwife or Aboriginal Midwife-Requested Assessment (MAMRA) by Video
• A817A – Midwife or Aboriginal Midwife-Requested Special Assessment (MAMRSA) by Video
• A818A – Midwife or Aboriginal Midwife-Requested Anaesthesia Assessment (MAMRAA) by Video

Adjustments to these claims include:

• Claims previously paid at the shadow billing rate will now pay Fee-For-Service
• All previous Fee-For-Service threshold accumulations for these services in the 2022-2023 and 2023-2024 fiscal years will be reversed
• All previous outside use accumulations for these services will be reversed

Please note during the medical claims adjustments process, the claims processing system selects an entire claim and reprocesses it. A single claim can include multiple fee codes and all codes will be reprocessed.

Please note that claims reprocessed with no change in payment will appear on the Remittance Advice 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 to zero with no payment impact but will be reported on Remittance Advice for reconciliation purposes.

No action is required on the part of the physician.

Keywords/Tags

Family Health Organization; FHO; Virtual Care; Included Codes; Excluded Codes; Core Service; A010A; A011A; A814A; A817A; A818A; A906A; A913A; A914A; Midwife; GP Focus

Contact information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524. Hours of operation: 8:00 a.m. to 5:00 p.m. Eastern Monday to Friday, except holidays.