Details on the change to Mandatory Electronic Billing

From "Rounds" June 2005

Manitoba Health administers more than 16 million fee-for-service claims for insured services each year.  Nearly 14 million claims are submitted electronically, and the others are submitted as paper claims. Of the 2,300 physicians who bill fee-for-service, about 600 physicians submit paper claims, although many do so only with respect to limited aspects of the practices.

MHSC employs 12 people for the initial phase of processing electronic claims, and 23 people (6 paper coders and 17 data entry clerks) for the initial phase of processing paper claims.

Physicians and the Association have expressed concerns for many years about the timely and efficient processing of fee-for-service claims.  MHSC has acknowledged that its claims processing turnaround time has been less than ideal, but has found itself constrained by the high proportion of staff resources dedicated to the processing of paper claims.

For about a decade, Manitoba has been the only province that permits the submission of paper claims without charge or restriction.

Newfoundland, Saskatchewan and Quebec permit the submission of paper claims with charges of $.29 and $.80 per tariff in Newfoundland and Saskatchewan, respectively, and $.25 per claim in Quebec.

BC and Ontario permit submission of paper claims with charges of $.40 per tariff and $2.00 per claim, respectively.  Also in BC, only physicians earning under $72,000 per year in fee-for-service income or providing fewer than 24,000 services per year are permitted to submit paper claims; all other physicians must bill electronically.  In Ontario, only physicians registered to practice in the province prior to 2003 are permitted to submit paper claims

Alberta, New Brunswick, Nova Scotia and Prince Edward Island do not permit the submission of paper claims at all.

In view of the foregoing, MHSC and the Association have agreed that, Effective April 1, 2007, fee-for-service claims in Manitoba must be submitted electronically.  This change will not apply to physicians who “shadow bill.”  The Association will provide more information in the months ahead to assist physicians with the transition from paper to electronic claims submission.

The MMA did not support the introduction of a charge for submission of paper claims because it would not improve MHSC’s claims processing efficiency, and because it would be less costly overall for physicians to utilize a service bureau to handle the submission and reconciliation of electronic claims than to pay MHSC a fee to process paper claims.
Once all fee-for-service claims are submitted electronically, MHSC will reassign employees who currently process paper claims to focus on processing electronic claims and/or to processing of claims queries.  This new approach is expected to markedly improve MHSC overall claims processing performance, thereby benefiting all fee-for-service physicians in the province.

Contact us now to find out how we can help you: e-mail us at inquiries@billingoptions.ca