When doctors in British Columbia submit claims to the Medical Services Plan (MSP), their claims can be temporarily 'held' and payment delayed.
Held claims are then manually reviewed by an MSP adjudicator. This means the on hold time is determined by MSP's volume and staffing availability.
How long will it take?
There are millions of claims submitted per month, and after being held, a claim must be reviewed by a live person.
They will investigate and determine whether the claim will be adjusted, released or denied. As you can imagine, this takes a lot of time.
While MSP likes to have claims processed within 30 days, this is often not the case.
You can expect for it to regularly take much longer – MSP can hold a claim for up to 18 months, but we find that they normally do not hold any claims longer than 6 months.
Processing times may also vary throughout the year due to staff shortages, holiday periods, new graduate classes starting and annual renewals.
MSP can receive a large influx of claims at these times and this will slow the manual review process down.
Why are my claims being held?
MSP will not release details as to why your claim is on hold until after they have finished processing it.
There are a variety of reasons why claims are held, and it's not always necessarily anything that is within your control.
However, our team has helped doctors submit over $50,000,000 worth of claims, so we know a few common reasons why claims may be held.
5 situations that delay MSP claims
1. Multiple procedures billed on the same day can hold up a claim as they need to be reviewed and approved.
2. Continuing Care from Previous Patient (CCFPP) claims lack notation. These claims may also be held until the initial call out has been paid, and may require more than one resubmission as a result.
3. Some critical care fees billed do not permit call outs as it is deemed included and therefore the rules need to be double-checked.
4. Any claim where the note is longer than 20 characters cannot be read electronically by MSP will automatically be dropped into manual review.
5. Lastly, we find that with all new billers they do this to review your billing patterns and look at claims of what is being billed. This is standard for most and should resolve shortly.
We know that having your claims held can be frustrating, but we hope this sheds some light as to how the process works and what you can expect.
Medical billing can be complicated – learn how Dr. Bill makes it simple »