Billing MSB can result in having claims sent back with payment lists or files, reject files or returned claims detailing various issues with submitted claims.
Below is a list of explanatory codes that you may see on your reports, along with a description of what the issue is:
AA – Not registered--no record of this person under this number. Please recheck the patient's Health Services Card.
AC – Incorrect sex indicated on claim-Medical Services Branch (MSB) has paid this claim. Please use the sex shown on the Health Services Card for future claims.
AD – Incorrect Health Services Number indicated on claim-Medical Services Branch (MSB) has paid this claim. Please use the number shown on this payment file/list for future claims.
AE – Incorrect date of birth indicated on claim-Medical Services Branch (MSB) has paid this claim. Please use the birth date shown on the Health Services Card for future claims.
AF – Please review this claim, the Health Services Number is inconsistent with the name, sex or birth date on the Health Services Card.
AG – This claim is for a newborn (child less than one year old). The newborn may not be registered yet/or the patient identification data is incorrect. Please ensure the beneficiary data is correct or that the parents/guardians contact Health Registration, 2130 11th Avenue, Regina, S4P 0J5 in order to have the newborn registered.
AH – Please review this claim. Our records indicate that the beneficiary registered under this number died prior to the date of service.
AJ – The services involving emergency room coverage cannot be paid as: 1) The physician is not eligible to bill these codes; 2) Another physician has been paid for the same time period in this community; 3) The incorrect dummy HSN has been used for this community; 4) An incorrect clinic has been used for this community; 5) Another ICD code must be used for regular services provided to a beneficiary; or 6) An incorrect service code, day of the week or amount has been used.
AL – This claim was received at the Ministry of Health prior to the date of service indicated on the claim.
AM – A letter sent to this patient by Health Registration regarding the validation renewal stickers has been returned. This patient will not have coverage after January 31. When you next attend to this patient, please advise him/her to immediately contact Health Registration at 1-800-667-7551 or 306-787-3251 to have their coverage updated. Please ignore this message if the patient now has a new expiry sticker.
AO – A letter sent to this patient by the Ministry of Health has been returned. Therefore, the patient's coverage has been terminated. On your next contact with this patient, please advise the patient to immediately contact Health Registration at 1-800-667-7551 or 306-787-3251 to have their coverage updated.
AP – The 9-digit Health Services Number is incorrect. Please recheck your files and/or the patient's Health Services Card.
AQ – This claim was previously assessed by a medical consultant based on the report received. Please do not re-submit the same report. If you wish to request a review of this decision, please submit the additional information, including the reasons and details of the request, on a Request for Review of Claims Assessment form and fax to 306-798-0582 or mail to: Medical Consultants, Medical Services Branch, 3475 Albert Street Regina SK S4S 6X6
AR – Patient not registered for coverage on this date of service. Please check the effective and expiry dates on the Health Services Card. If the patient is a resident, he/she should immediately contact Health Registration, phone 1-800-667-7551 or 306-787-3251, 2130 11th Avenue, Regina, S4P 0J5, in order to have coverage updated.
AS – Your account had to be split for processing. Payment for the listed services was approved based on the Ministry of Health's Payment Schedule.
AT – Diagnosis and Payment Schedule item are not compatible.
AU – To assist in the assessment of this service please submit a request for review of claims assessment form with a copy of the operative report, medical record or a descriptive letter. PLEASE NOTE: • If an operative report is being submitted, it must contain surgical start & end times. • The run code and claim number must be included. • The claim itself should not be resubmitted electronically.
AV – This service is not insured.
AW – This Payment Schedule service code applies to a certain location of service; the location of service you submitted is not compatible.
AX – A Medical Consultant has reviewed this claim. The circumstances described are not considered sufficient to warrant additional payment.
AY – Assessed by a Medical Consultant.
AZ – Please refer to correspondence.
BA – Duplicate--same physician--payment has been made for the same service provided on the same day. Please check your records for a duplicate payment and only resubmit the claim if the service has not been previously submitted and paid.
BB – Possible duplication of a payment for a similar service. If no duplication, please resubmit with a note in the "Remarks" area on the claim or a comment record in the automated claim submission.
BC – Duplicate--same clinic--payment has been made to another physician in your clinic for a similar service on the same day. Please check your records for a duplicate payment and only resubmit the claim if the service has not been previously submitted and paid.
BD – The beneficiary has been paid for a similar service provided on the same day.
BE – This Payment Schedule service code applies to a specific age or sex.
BF – Adjustment based on correspondence - Re: "Audit of Services".
BG – This Payment Schedule service code was submitted at less than the listed rate. 1) If this claim has been returned to you, please correct and submit at the current rate. 2) If this claim has been adjusted by Ministry Officials, the appropriate rate for the date of service has been approved.
BH – Payment Approved at: 1) Listed rate for a specialist in your specialty. 2) Equivalent service code and fee listed in your specialty. Re: Definition of "Specialist".
BI – Paid at the unreferred rate because of one of the following: 1) The referring physician has not practised in Saskatchewan during the past two years; 2) The 4-digit referring doctor is not valid; 3) We could find no record of the "referring physician" being licensed to practice; or 4) No referring doctor number was submitted.
BJ – Payment for this item can only be made if the patient was referred and the 4-digit referring doctor number is indicated in the appropriate field. Please re-submit: 1) if referred, with the 4-digit referring doctor in the appropriate field; 2) if unreferred, using appropriate code and fee.
BK – Payment based on the service code and related payment approved by the Ministry of Health.
BL – Please be advised: 1) This service is currently being discussed with the Saskatchewan Medical Association Tariff Committee; OR 2) This item is not currently an insured service; please contact the SMA Tariff Committee to apply for a new service code.
BM – Unilateral/bilateral procedure--please re-submit indicating left/right or bilateral.
BN – You were asked for additional information to assess this claim, no reply received -- without this information, the claim cannot be processed.
BO – The approved service code and payment is based on your description of the service.
BP – Payment adjustment based on: 1) your resubmission; 2) our review of assessment; OR 3) information received on Review of Claim Assessment form.
BQ – The service code and/or amount submitted are incorrect. Please review and resubmit.
BR – Invalid service code -- please review.
BS – The service code submitted is not correct for the condition described; or the service(s) provided.
BT – Approved at the maximum amount consistent with your description of the service provided.
BU – Payment not approved for: 1) Surcharge alone; 2) Surcharge with: a) another surcharge code: 615A, 721A, 815A, 816A, 817A, 818A, 819A, 836A, 837A, 838A, 839A or 915A; b) service codes 41A, 56A, 60A, 70A, 71A, 74A, 153A-156A, 184A, 190A-198A, 600A, 626A, 680A, 681A, 708A-710A, 714A-718A, 725A-727A, 753A, 42B-44B, 60B-68B, 73B, 85B, 200B, 205B, 206B, 30D, 31D, 32D, 130D, 131D, 145D, 278D, 279D, 281D-285D, 290D, 291D, 300D, 320D, 500D, 501D, 43E, 142E, 144E, 400H-424H, 667H, 80J-81J, 278K, 279K, 452L, 31M, 492N-493N, 42O, 44O, 260P, 261P, 300T; c) hospital care codes, including newborn care, supportive care (52B-53B); d) a pre-arranged service; e) phone calls or faxes (70A, 761A–769A and 790A-795A). 3) Surcharge for an extra patient not paid for the day and time indicated. 4) Premium service codes should not be submitted based on the eligible service codes being paid. They are automatically generated by the Ministry of Health. 5) Surcharges for emergency room physicians providing emergency room shifts or first on-call services. 6) Hospital care surcharge: 700A for non-statutory holidays, and 701A if not Saturday or Sunday. 7) Extra patient surcharge not paid with 335H to 339H. Initial patient surcharges paid only once per patient per day.
BV – Payment based on the appropriate service code and amount listed for the date provided.
BW – Billed more than listed payment - appropriate payment for the date of service has been approved.
BX – This is a time-based service: 1) Time requirements have not been met; therefore, no payment can be made; or 2) The service code descriptor states “greater portion thereof” or “major portion thereof”, and the greater/major portion of the time component has not been met; therefore, the additional time units are not payable.
BY – Payment on a time basis--please designate the treatment time and resubmit.
BZ – Payment is based on the amount payable to a Saskatchewan physician in the same specialty providing the same or similar service.
CA – Medical examinations, services and provision of certificates or reports requested by a third party, e.g. for: • Attendance at camps • Autopsies • Daycare • Employment • Employment Insurance Program • Insurance • Judicial purposes (other than adoption or commitment) • Motor vehicle or other license (MSB pays some services for SGI) • Participation in Sports • Passport or Visa • Seat belt exemption • Third party counselling • University or private school entrance
CB – Materials & other services--e.g.: • Acupuncture • Advice by telephone or letter (most) • Ambulance services • Anesthetic materials • Appliances (Prostheses) • Casts • Committee or Advisory service • Contractual Service for a government department or agency • Dentistry • Dressing or medication • Drugs • Eyeglasses or Contact Lenses • Facility fee • Medical testimony in court • Medical-legal opinion and report • Secretarial or reporting fee(s) • Services by a special duty nurse • Surgical supplies • Travel by a physician • Tray service (see service codes 897L and agency 899L for description)
CC – Immunization services--when available under the Ministry of Health programs. If this patient was referred by the Ministry of Health personnel or there are medical factors which prohibited immunization under the Ministry of Health programs, please resubmit with an explanation.
CD – Hospital Services: 1) Services provided by: a) Hospital personnel; or b) Any out-patient facility having a contract with the Ministry of Health. 2) The technical component of a diagnostic procedure performed in a hospital utilizing hospital equipment, e.g. ECG, EEG
CE – A service by a physician who is not registered with or licensed by the appropriate agency of the Province, State or Country on the date the service was provided.
CF – This service code is not valid for this date, because it is either: 1) Prior to implementation; or 2) After deletion from the Payment Schedule.
CG – The College of Physicians and Surgeons has declared it unethical for a physician to bill for services provided to him(her)self, spouse or children.
CH – These services appear to be the responsibility of the Department of Veteran's Affairs (DVA.). • Please send the appropriate form to DVA: Treatment Benefit Unit, Box 6050, Winnipeg, R3C 4G5. • If they do not accept responsibility, please resubmit the claim electronically with the comment “Not responsibility of DVA”.
CI – The service provided cannot be paid for an out-of-province beneficiary; it is on the excluded list of services for reciprocal billing purposes or it cannot be billed under the reciprocal billing process.
CJ – Our records indicate this patient was not in the hospital on this date. If this information is incorrect, please resubmit with the admission and discharge dates.
CK – This service is not insured - our records indicate that the beneficiary died more than 30 days prior to date of service.
CL – In-hospital services for which payment may be funded by the Ministry of Health.
CM – Claims received more than six months after the date of service. A resubmitted claim must be returned within 1 month. If factors beyond your control prevented submission within 6 months, the following details must be received in writing addressed to the Manager, Claims Unit (fax: 306-798-0582): 1) List of claims for which you are requesting the time limit approval; 2) Service codes and dollar amounts; 3) Number of patients; 4) Dates of service; 5) Circumstances for the delay in submitting your accounts; and 6) Date of submission.
CN – Claim received more than twelve months after the date of service cannot be accepted for any reason.
CO – Date of Service is prior to: 1) The physician's registration date; OR 2) The effective specialty date as indicated by the College of Physicians and Surgeons of Saskatchewan.
CP – Our latest information from the College of Physicians and Surgeons of Saskatchewan indicates that you are registered in Saskatchewan as a General Practitioner.
CS – Department of Veterans' Affairs - has advised the Ministry of Health that they have paid you for this service.
CT – Workers' Compensation Board has advised the Ministry of Health that they have paid you or another physician in your clinic for the same service, a similar related service or a service which includes post-operative care.
CU – Payment is based on one of the following: 1) Payment is only approved for those physicians listed by the College of Physicians and Surgeons of Saskatchewan, State Board, Regional Health Authority or Saskatchewan Medical Association Tariff Committee in their practice locale as having qualified to receive payment for this service or approved according to requirements listed for a particular service code. 2) List I and II laboratory services are only payable when provided in a medical laboratory which holds a Category I licence issued pursuant to The Medical Laboratory Licensing Act.
CW – These services appear to be the responsibility of the Workers' Compensation Board (WCB.). Please submit a claim to the WCB. at Suite 200 - 1881 Scarth Street, Regina, S4P 4L1. If they do not accept responsibility, WCB. will forward the claim to you. If the claim has not yet been paid, please submit an automated claim to MSB with a comment “Not WCB” followed by the date submitted to and rejected by WCB.
CY – This service not usually billed by a physician in your specialty.
CZ – Service Code of 20A can be on the same claim number as visit codes, laboratory services, 131A, 204A, 205A, 206A, 30D, 31D, 32D and 815A-839A. Also a diagnostic code of Z90 should only be used in conjunction with a claim containing a service code of 20A.
DA – Only one visit type service is approved during a single patient contact. If there were 2 separate patient contacts, please resubmit with the reason and time of the second visit.
DB – Please clarify the second visit on the same day by the same physician or the same specialty and clinic.
DC – Multiple diagnoses during a single patient contact. Another agency appears to be responsible for the assessment and/or treatment of one condition. Payment of services for another condition is not approved.
DD – Please verify date(s) of service and resubmit.
DE – Included in the payment for another service provided during the same Physician/Patient contact.
DF – Codes 64B-68B are only payable once per patient every 90 days; we have adjusted your payment to a similar visit service.
DG – Please resubmit under the Health Services Number of the patient to whom you provided the service.
DH – Please identify the person(s) interviewed, e.g., wife, son, employer, teacher, etc.
DI – A return visit on the same day by either the same physician or another physician in the same specialty and clinic for the purposes of reviewing or taking of x-rays and/or ultrasounds is regarded as an inclusion in the first visit service.
DJ – Third party counselling billed under codes 40B/41B must be billed under the name of the person counseled, not the patient.
DK – Third party counselling billed under codes 15C/16C must be billed under the name of the child (not the parent/caregiver/relative, etc) regardless of who is being counselled.
DL – Surcharge 721A applies to a life-threatening situation and admission to hospital -- the information given on your claim does not indicate the necessity for an immediate "STAT" response regarding a life-threatening situation. Your surcharge may have been adjusted to another surcharge based on the information provided. If resubmitting, please provide further information or submit under an alternate surcharge.
DM – Payment is made for this visit when provided in the physician's office only when the claim confirms a "Visit - Specially Called" made after regular office hours or on a holiday. Please resubmit with explanation.
DN – Surcharge 721A does not apply where the patient is already hospitalized.
DO – Our record and your service description indicate that this service appears to be inconsistent with the definition of a special call.
DP – Service codes 220A-226A, 918A, 919A, 926A-928A, 335H to 339H and most 400H-424H services -- include all services provided during this time. Payment based on your description of services.
DQ – Additional patient--payment has been previously approved for a special call made to another patient at the same location on the same date. If you were "specially called" a second time and returned to provide this specific service please resubmit for the difference in payment under the initial service code with a notation confirming the return visit.
DR – Service codes 220A-226A, 918A, 919A, 926A-928A, 335H-339H relate to the time actually spent with the patient, and all services provided during this time. Please indicate: 1) Time when service started and was completed. 2) Clinical factors necessitating the personal attendance/indirect care/resuscitation. 3) Services provided during that time.
DS – Service codes 220A-226A and 918A are not paid when other service codes apply.
DT – Continued hospital care—payment is based on continuous hospital care. 1) Assessment Rules – “Hospital Care”, item b
DU – Our records indicate that the beneficiary was a hospital in-patient on the date of service. a) Payment adjusted to the appropriate item for hospital care. b) Payment rejected. Please verify location of service.
DV – 926A applies to the actual time spent in transit with the patient. Please resubmit indicating: 1) Location from which patient was transferred, 2) Location of hospital to which patient was transferred, 3) Times of departure and arrival.
DW – Multiple visits--hospital--the payment for daily in-hospital care is a maximum regardless of the number of visits made by the physician. 1) Assessment Rules - "Hospital Care", item a.
DX – Concurrent care -- payment has been made to another physician for daily hospital care for this period. Payment to a second physician is only approved when a satisfactory explanation is provided that care by two physicians was required.
DY – Special Call or emergency visit--in-hospital care- will not be approved for a hospital in-patient without additional information. Please resubmit with an indication of the factors requiring the visit. Re: "Assessment Rules" - "Hospital Care", item d.
DZ – "READMISSION" must be indicated in order to be eligible for the higher rate of payment when a patient is readmitted within 14 days. Re: Assessment Rules - "Hospital Care", item b.
EA – Consultation converted to a repeat. Re: Assessment Rules - "Consultations", items f(i) and (vi).
ED – A Medical Consultant has reviewed this claim. The diagnosis does not seem to indicate the necessity for a Consultation. If resubmitting, please provide a copy of the consultation report.
EL – Consultation converted to a partial/follow-up assessment. Re: Assessment Rules - "Consultations", item f(ii).
EM – Complete/initial assessment converted to a partial/follow-up assessment. Re: Assessment Rules - "Consultations", items f(iii), (v) and (vii).
EN – Consultation converted to a complete/initial assessment. Re: Assessment Rules - "Consultations" - items f(iv) and g.
EO – An initial in-hospital consultation on the same day or within 42 days after a complete/initial assessment is converted to a complete/initial.
EP – An initial in-hospital consultation on the same day or within 90 days after another consultation is converted to a complete/initial assessment.
ER – Your claim has been assessed based on one of the following: 1) A previous 52B has been paid for this admission; only 1 payable. If this is a readmission, resubmit indicating the date of admission/discharge 2) Second 53B is not payable within six days. 3) This patient does not appear to be under the care of a specialist; please resubmit with the name of the attending specialist.
ES – A follow-up visit on the day of a 42-day elective procedure, is not approved when seen by the physician within the previous 30 days
FA – Paid at the greater of the procedure or visit/consultation. 1) Assessment Rules - "Multiple Services", Rule 1 2) Payment Schedule Listing.
FB – Minor procedures for which no payment is listed are considered an inclusion in the visit or consultation.
FC – Second procedure paid at 75% when performed bilaterally. Re: Assessment Rules - "Multiple Services", Rule 5.
FD – This service code is listed as a bilateral procedure. Therefore, only one (1) is payable per patient contact.
FE – The greater payment approved: 1) Procedure not approved in addition to another service. 2) Included in the payment for the procedure. 3) Assessment Rules - "Multiple Services", Rule 1. 4) Payment Schedule listing.
FF – Maximum approved--this service with prior services by the same physician or clinic would exceed the maximum.
FG – Multiple interpretations billed on the same date. Please resubmit indicating if these interpretations are for tracings done on different days, the time and reason for multiple interpretations.
FH – Technical component not approved. Only the interpretation component can be approved when this service is provided in any part of a hospital. If not provided to either an in-patient or an out-patient, please resubmit designating the locale.
FI – Considered an inclusion within the payment for a related procedure.
FK – Echocardiography service code and payment is adjusted or rejected based on prior services by the same physician or clinic in accordance with annual maximums.
FM – Approved only with specified services as listed in the Payment Schedule.
FP – A "0" or "10" day Procedure billed in addition to a visit (including hospital care) or consultation--approved at the greater of: 1) The procedure alone; OR 2) The visit plus the procedure at 75%. Re: Assessment Rules - "Multiple Services", Rule 2.
FS – Approved as repeat procedure--previously paid to you or to another physician in the same specialty and clinic.
FT – Code 34F, PUVA therapy, is paid once only on alternate days. Repeat billings are converted to 150A.
FY – A code and a fee have been approved by the Ministry of Health that are not yet available for billing. A temporary code has been used to process your claim.
FZ – The calculated premium is based on the submitted service code and is paid as the premium approved service code. The amount has been calculated using the appropriate premium percentage multiplied by the approved amount plus the age (or pediatric) supplement when calculating time of day premium of the eligible service code
GD – Payment for report is not approved 3 days proceeding, the day of, and 3 days after a consultation.
GE – Payment for report is not approved during the usual post-operative period.
HA – Based on the total payment (calculated at the specialist rate, regardless of "repeat surgery rule" or surgery by a general practitioner) for the procedure(s) performed. Re: Section "H", item 3.
HB – Service converted to the appropriate service code for the start-up approved.
HC – Another service provided during a period of intensive care has been paid in lieu of that period of 335H-339H or 420H-424H series.
HD – "Standby" - Please indicate: 1) The physician who requested the "standby", 2) The commencement and completion times of both the "standby" and the anesthesia, and 3) The services provided during the "standby". Re: Section "H", item 7.
HE – Included in payment of anesthesia. E.g., Consultation is not approved to the physician who also provided Anesthesia same day. Re: Section "H", item 1 and 2.
HG – Paid as a second anesthetist. Re: Section "H", item 6.
HH – This service, with previous 335H-339H or 400H – 424H services, exceeds the listed maximums (see Payment Schedule). Adjusted to the approved service code and fee.
HL – Payment for general anesthesia for dental procedures outside a hospital restricted to specialists in anesthesia. 1) Definitions -- "Specialist". 2) Information for Physicians -- "Services Not Insured by the Ministry of Health".
HN – Nerve Blocks, Section H. 1. Greater payment approved -- nerve block and other service(s). 2. Nerve blocks are not payable in addition to a surgical procedure on the same day when provided by the same surgeon: • See explanatory codes KB and KH; and • Assessment Rules, “Procedures”, item 3 (c).
HO – Greater payment approved -- Pain Clinic and other service.
HP – Epidural anesthesia provided during labour and delivery should be billed as service codes 600H, 601H, and 667H.
HQ – Approved only for services by a specialist in a designated Pain Clinic
JA – Payment for assistance is not approved for this procedure unless special circumstances satisfactory to the Ministry of Health are described. Please provide details. Re: Section "J", item 2.
JB – The additional time code did not correspond with the base code.
JC – Payment is to be based on the induction of anesthetic to when the surgical assistant is no longer required – payment has been adjusted based on billed anesthetic time
JD – Assistant standby not paid if assistant fees are billed.
JE – Payment for more than one surgical assistant is not approved for this type of surgical procedure unless special circumstances satisfactory to the Ministry of Health are described. Re: Section "J", item 3.
JF – We are unable to process this claim as the surgery claim has not been received. Please contact the surgeon to submit the surgical claim, and then resubmit your claim.
JG – 1) 80J/81J are for office-based physicians who earn less than 50% of their income through surgical assisting. 2) 80J/81J is for scheduled surgeries performed between 8:00 am and 5:00 pm, Monday to Friday. If your claim has been rejected or converted to another surgical assistance code, it is because: a) The service was not provided between 8:00 and 5:00 pm Monday to Friday; b) The service was billed with a premium location (B, K, M, C); c) The service was billed with a surcharge (815A-839A); d) The physician was not eligible to bill this service because he does not earn less than 50% of his/her income through surgical assisting; e) The service was billed on a statutory holiday or weekend.
JH – Service codes 540H, 545H, 580H, and 585H are not billable by the surgical assistant with J section codes. These service codes are only payable to the anesthetist who is providing the anesthetic service with H section codes.
JM – Control of post-op hemorrhage in the first 24 hours is included in the composite fee for the surgical procedure.
JN – Considered an inclusion within the payment for a more major procedure.
JO – Paid in accordance with rules for two or more procedures performed on the same day by the same physician, another physician in same specialty and clinic or part of the surgical team. Re: Assessment Rules - "Multiple Services", Rule 8.
JP – Claim is being rejected because this code has been billed and paid to another physician.
JQ – Paid at the maximum listed for these multiple procedures. Re: Payment Schedule item.
JR – Paid at 1/3 of listed payment when a surgical procedure is performed by 2 specialists and payment is not defined for the second surgeon.
JS – Complex incisional hernia with Inlay mesh (246L): 1. Your claim is being rejected because you have not included the payment criteria as required under code 246L. 2. Your claim is being converted to 245L “incisional hernia” because the payment criteria have not been met; please do not resubmit this claim.
JT – The bilateral procedure payment is approved when unilateral procedures are staged during the same hospital admission. Re: Assessment Rules - "Multiple Services", Rule 9.
JW – Paid as a repeat or related procedure within the designated post-operative period. Re: Assessment Rules - "Multiple Services", Rule 10.
KA – An inclusion in the payment for the procedure when provided by the same physician, another physician in same specialty and clinic or part of the surgical team. 1) Assessment Rules - "Procedures", items b and d - "Multiple Services", Rule 8 (a). 2) Various Payment Schedule items.
KB – The anesthetic is an inclusion in the surgical fee when provided by the same physician.
KC – Initial visit or consultation provided on the same day as a 42 day procedure is converted to a partial/follow-up visit.
KH – Only the greater payment is approved when a physician acts in more than one capacity, e.g. anesthetist, assistant or surgeon.
KM – Diagnostic procedure on the day of a "42" Day procedure approved at 75%. If the diagnostic procedure is a greater value than the 42 day procedure, the diagnostic procedure is payable at 100% and the 42 day procedure at 75%. Re: Assessment Rules - "Multiple Services", Rule 6.
KN – Related diagnostic procedure during the designated post-operative period of a "10" or 42 Day procedure approved at 75%. Re: Assessment Rules - "Multiple Services", Rule 7.
KO – The two days of pre-operative care in hospital are included in the payment for a "10" or 42 Day procedure.
KP – Visit (including hospital care) or consultation, same day, is included in the payment for a 42 Day procedure when provided by the same physician, another physician in same specialty and clinic or part of the team. Re: Assessment Rules - "Multiple Services", Rule 3.
KQ – Inpatient visits (including hospital care) or consultation during the designated post-operative period of a related "10" or “42” Day procedure is included in the payment for procedure when provided by same physician, a general practitioner in the same clinic or a specialist in the same specialty and clinic. Re: Assessment Rules - "Multiple Services", Rule 4.
KR – Only one special call is approved per major surgical procedure or dislocation.
KS – Codes 232L and 142P are only payable for Malignancy. Code 142P is only payable in addition to 123P or 134P.
LA – 348L included in payment for 355L.
LB – The 898L is for removal of sutures and/or staples from lacerations or surgical incisions (i.e. 10 or 42 day procedures).
LC – 890L - 895L -- please indicate: 1) The total length of the lacerations by site. 2) The length of the facial component of any laceration extending from facial to non-facial area. Re: Payment Schedule items.
LD – Approved only with specified services as listed in the schedule under payment item 897L, 899L, 181S or 300T, where provided in a physician's office.
LE – Please identify the site and extent of burn area. Re: Payment Schedule item.
MB – Included in the "composite" paid for the initial immobilization or closed reduction. 1) "Fractures", items 1, 2 and 3 2) "Dislocations", items 1 and 2.
MC – Maximum for undisplaced fracture. Re: "Fractures", item 2.
MD – Paid as closed reduction plus 50%. Re: "Fractures", item 3(c)(ii).
ME – When an "open reduction" or a "closed reduction with external fixation" is performed by any physician within the post-operative period of a previous attempted reduction, the payment for the prior fracture is reduced by 50%. 1) "Fractures", item 3(c) 2) "Dislocations", item 2.
MF – Payment for the previously attempted reduction is reduced by 50%. 1) "Fractures", item 3(b) 2) "Dislocations", item 2.
MH – Reduction of a dislocated hip within the post-operative period is included in the arthroplasty payment.
MI – "Fracture" and "dislocation" - same date - same site - greater payment approved.
ML – 133M: the source of the autogenous bone from a different site has not been identified.
MM – 31M, 32M, or 33M: NOT paid in addition to, or part of, another orthopedic procedure, performed through the same or extended incision by any physician.
MP – Synovectomy not paid in addition to major joint surgery.
NB – Care provided for cosmetic purposes is not an insured service. Re: Information for Physicians - "Services Not Insured by the Ministry of Health."
NC – 382N & 383N--restricted to a "plastic surgeon" treating a referred patient; 890L approved.
ND – 287N for reconstruction of nose not paid in addition to rhinoplasty. April 1, 2013 IN.44
PA – Delivery bonus for GP physicians only – additional 25% payable on the first 25 of either 41P or 42P services in each year beginning April 1.
PB – Included in the payment for delivery and post-natal care in hospital. Re: "Obstetrics", item 4(a-g).
PG – 42P approved - patient was turned over to consultant who provided the delivery. Re: "Obstetrics", item 2.
PH – 40P or 4lP is only approved for the delivery of a viable foetus of 20 weeks or more.
PI – Only one special call surcharge is approved per confinement (case).
PL – Payment approved as subsequent pre-natal or post-natal care.
PS – Two complications of pregnancy may be claimed per patient per pregnancy. Report required for more than 2.
PU – Continuous personal attendance is not paid with a delivery
QA – 1. The claim submitted has hospital dates that span two different Payment Schedule rates. Please resubmit claim(s), with correct fees for the date(s) of service; or 2. This claim has laboratory services and an ECG service; please resubmit with the ECG on a separate claim.
QB – The fee submitted is incorrect for the Payment Schedule rate in effect on the date of service. Please update your system with the current Payment Schedule rate(s) OR if you’ve already updated your system with the new rate(s), please check the date of service if it is prior to the effective date of the new rate, and then resubmit your claim with the correct fees.
QC – Number of units submitted is incorrect. Either this service does not have units or the number of units is greater than listed in the Payment Schedule. Resubmit with the correct number of units and fee. Services which do not have units must be submitted on an individual line.
QD – 700A is only billable on a Statutory holiday (or on the day designated in lieu, when the statutory holiday falls on a Saturday or Sunday). 701A is only billable on a Saturday or Sunday. Resubmit with the correct date of service.
RA – To assist Ministry Officials in the routine monitoring and review of practitioner payments, please provide a copy of the medical record and/or the appropriate documentation to support this billing. For inquiries related to this information, please contact: Policy, Governance and Audit: Phone: 306-787-0496 Fax: 306-787-3761 Email: MSBPaymentsandAudit@health.gov.sk.ca
RB – This adjustment is being made as a result of a routine audit undertaken by Policy, Governance and Audit of Medical Services. For inquiries related to this payment, please contact: Policy, Governance and Audit: Phone: 306-787-0496 Fax: 306-787-3761 Email: MSBPaymentsandAudit@health.gov.sk.ca
RC – This claim is being returned. Policy, Governance and Audit will adjudicate this claim and make the appropriate adjustment if warranted. Please do not resubmit electronically. For inquiries, please contact: Policy, Governance and Audit: Phone: 306-787-0496 Fax: 306-787-3761 Email: MSBPaymentsandAudit@health.gov.sk.ca
RD – This service appears to have been pre-planned/pre-arranged. If the claim was billed with a surcharge (815A-839A or 721A), please provide: 1) the time of day that the service was provided; 2) the physician’s location when he/she was called out; and 3) the reason for the special call.
RE – This service was billed with a time-of-day premium (B, C, D, E, F, K, M, P, T); please provide the time that the service was provided.
RV – This service is being recovered as a result of a routine verification. The beneficiary does not recall receiving this service. Please provide a copy of the medical record that supports the service billed and submit it to: Policy, Governance and Audit: Phone: 306-787-0496 Fax: 306-787-3761 Email: MSBPaymentsandAudit@health.gov.sk.ca
SA – 6S--A previous examination was provided to this beneficiary by yourself or another physician within the designated time span: 1) Age 18 - 64 minimum time - 24 months; 2) All other ages minimum time - 12 months. If resubmitting, please indicate: 1) Previous and current complete refractive errors. 2) Medical factors necessitating current refraction. Re: "Ophthalmology", item A(c).
SB – 170S-171S--included in payment for retinal detachment. Re: Section "S", item B.
SC – 12S, 581S, 582S--approved only once within a period of 12 consecutive months for the same physician or clinic.
SF – The factors indicated have been reviewed and are not considered sufficient to warrant payment of a second refraction within the designated time span.
SS – Coverage for routine examination of the eyes (6S) is limited to those under the age of 18, Social Assistance recipients nominated to receive Supplementary Health benefits, recipients of Family Health Plan benefits and seniors receiving the Saskatchewan Income Plan supplement. According to our information, the patient is not eligible for coverage.
VB – Procedure not insured in office practice. Re: Lists 1 and 2.
VC – 204-206A--not approved in addition to any other service. Re: Payment Schedule item.
VD – 204-206A, 756-758V & 770V-772V --payment includes referral of multiple specimens of the same type. Re: Payment Schedule item.
VE – The appropriate Biochemistry Panel Code is approved based on the total number of tests per patient. Exceeds maximum number of units paid without an explanation.
VH – Exceeds maximum number of units paid without an explanation.
VI – Multiples of codes 32V plus urinalysis (60V) are being paid at the appropriate number of units for the composite code - 33V.
VL – According to information received from Laboratory Licensing, you have not been licensed to perform this test. Please review your licence. If any disagreements, please write to: Laboratory Licensing Ministry of Health 3475 Albert Street Regina, Saskatchewan S4S 6X6 email@example.com
VM – The code and payment approved is the maximum for the series.
VN – Included in the "composite" paid for the related laboratory procedure.
XA – Radiology is not insured when: 1) provided in: a) a hospital, or b) any facility funded by the Ministry of Health. 2) performed by other than a radiologist. Re: Section "X" - items 1 and 2.
XJ – Considered an inclusion within the payment for a similar procedure on the same day. If re-submitting please clarify.
YA – Patient's Name--please clarify the full name.
YB – Registration--indicate the complete 9-digit Health Services Number.
YC – Date of Birth--indicate the month and year of birth recorded on the Health Services Card.
YD – Family Head--please indicate the full name and address.
YE – The province code is blank, invalid or not legible. Please provide the necessary information in the "REMARKS" area.
YF – THE SIGNATURE BLOCK on this claim is completed differently than what you previously indicated to the Ministry of Health. The acceptable methods are: 1) Personal signature. 2) Impress a rubber stamp facsimile of the practitioner's signature 3) Impress a rubber stamp of the practitioner's name in capital letters. 4) Hand print the practitioner's name in capital letters. 5) Delegate a member of your staff to personally sign on the practitioner's behalf. Prior to resubmission, please complete the signature block by either: 1) your previously designated method of signing; or 2) personal signature. If you wish to change your previously designated method of signing claims, you must first advise The Ministry of Health in writing of the specific acceptable method you intend to use in the future.
YG – The Out of Province registration number provided on your claim is not correct. Please check your records and modify the number, if incorrect. If the number is correct according to your records, please indicate this on the claim.
YH – Additional information requested--Please ensure all the following have been provided: 1) Diagnosis 2) Site of lesion or injury 3) Cause and site of edema 4) Condition requiring the injection.
YI – Clarification - please clarify the item(s) circled on the claim or recheck the entire claim.
YJ – We cannot interpret the diagnosis. Please explain the term(s) used.
YK – Code and Fee--please indicate the service code and amount charged for each service.
YL – Date of Service--please indicate the proper day, month and year.
YM – Hospital visits--please clarify the date of the first and last visit and the total number of days billed.
YN – Please review this claim. The payment schedule code and/or diagnosis/diagnostic code is not consistent with the patient's age and/or sex.
YP – The clinic number is invalid for the submitted dates of service or the hospital days span two clinics. Please review the dates of service and clinic number.
YR – Please clarify the name, specialty and initials of the physician who provided each service.
YS – We are unable to identify who referred the patient. A referring physician's name either has not been supplied, or if a name is present on the claim, he or she cannot be located in our listing of active Saskatchewan physicians. If the patient was referred, please resubmit the claim with the full name of the physician and the location of his or her practice.
YT – Please resubmit the claim indicating the hospital admission and discharge dates.
YU – Your claim has been returned because of the omission of one or both of the following items: 1) Designation of the operative procedure. 2) The total time when additional time is billed.
YV – Please indicate whether the dental anesthetic was administered in a hospital.
ZA – The patient identity information on the claim (month or year of birth, sex or surname) does not correspond to information on the Health Services Card. Please check the Health Services Card, make the claim corrections and resubmit.
ZC – The submitted claim contains invalid data other than patient identification data, e.g. September 31, the submitted fee at zero dollars, the 13 month, a lower case alpha character, a partially blank field as HSN, wrong location of service, a service not allowed for premiums etc.
ZD – The dates of service or month of birth are invalid. The date of service may be greater than the date of computer processing, there are two months of service on the 50 record types with the same claim number or the number of hospital visits exceeds the number of days between the first and last hospital dates.
ZF – The physician is not eligible to submit for services on the indicated dates of service
ZG – A premium eligible and non-premium eligible service code cannot be billed on the same claim. Please verify your locations of service and resubmit on different claims if applicable.
ZH – Only Hospital visits (25 to 28 and 35B) may be billed in the hospital visit area or on a hospital care record (57). Please resubmit other services on a non-hospital visit/procedure record (50). The number of units or number of days billed can never exceed 99. on a computer submission, the 50 record must precede all 57 records with the same claim number.
ZL – The submitted referring physician number is invalid or an invalid referring physician number has been used for a non-cancer diagnosis or a nurse practitioner has referred to a physician that is not a specialist. Please check the referring physician name and number.
ZM – The claim contains an invalid diagnostic code according to the International Classification of Diseases - 9th Revision. Please check the diagnosis, diagnostic code and table of invalid codes.
ZN – The Ministry of Health has received multiple claims with the same clinic, physician, claim and Health Services Number. One of the claims is being processed; all other claims with the same claim number are being returned.
ZP – An invalid mode of payment or incorrect service code has been used on the claims or mixed services are being submitted for an APS claim (eg. 74A (SGI) and 5B or 600B)
ZR – The indicated location of service, service code or time is invalid for a premium payment on this date. (See "OUT OF HOURS PREMIUMS" section in Part A of this Payment Schedule).
ZS – This claim was submitted as a Professional Corporation (PC) claim; however no PC information has been received or the PC claim is not valid on this date.
ZT – Please refer to the comment record(s) being returned by MSB for a more detailed explanation.
ZW – The direct input claim cannot be processed. Please resubmit on a regular claim form.
ZY – The direct input claim cannot be processed. Please resubmit with comments or an explanation of the service provided. If an operative report or a detailed explanation is required, it should be submitted and attached to a regular claim form.