Important Billing Information for Providers

Comprehensive Care Management Tariffs - Effective April 1, 2017

Effective April 1, 2017, five new Comprehensive Care Management (CCM) benefit codes (tariffs) will be added to the Manitoba Physician’s Manual.  The complete tariff descriptions can be found here: www.gov.mb.ca/health/claims/docs/ccmtariff_2017.pdf.

Important information and billing tips for Comprehensive Care Management (CCM) tariffs:
  • The requirements for billing the new CCM tariffs add an increased level of complexity for claims adjudication, including a reliance on patient enrolment information and potential interactions with existing Chronic Disease Management (CDM) tariffs.
  • In an effort to ensure that MHSAL’s claims processing system is applying the adjudication rules as expected, Manitoba Health, Seniors and Active Living (MHSAL) will initially pend all claims with a CDM or CCM tariff billed, for a short period of time.  Your patience is appreciated during the final implementation stage of these new CCM tariffs.
  • To avoid other tariffs on your claim from pending, MHSAL recommends that you submit your CDM or CCM claims separately from any other visit or services performed on the same date of service.
  • There is a systematic one-day delay in the transfer of patient enrolment information to the Claims Processing System.  To prevent an automatic claim rejection, please wait at least one full business day after your enrolment information has been submitted before submitting your CCM claim.
  • CCM tariffs 8454 and 8455 should be claimed using ICD V700.
  • For CCM tariffs 8456, 8457, 8458, an ICD code specific to an eligible chronic condition must be submitted on the claim.
  • We encourage physicians, billing staff and vendors interested in learning more about the requirements for billing these benefits to access MHSAL’s CCM Tariff FAQ and the Manitoba eHealth Home Clinic site.
  • CCM Tariff FAQ: http://www.gov.mb.ca/health/primarycare/providers/clinic/ccmtariff.html
  • Manitoba eHealth Home Clinic Site: http://www.manitoba-ehealth.ca/emr-hclinic.html
  • Registering with MHSAL as a Home Clinic is a prerequisite to patient enrolment and, for fee-for-service clinics, to submission of claims for the Comprehensive Care Management tariffs (effective April 1, 2017). For further information or assistance with patient enrolment, please contact 204-926-6010, 1-866-926-6010 or homeclinic@manitoba-ehealth.ca.

  • Information regarding specific claims is available by calling the Claims Unit staff at CLAIMS ENQUIRY 204-786-7355.

- posted March 23, 2017


Comprehensive Care Management CCM Benefit Codes

On April 1, 2017, five new Comprehensive Care Management (CCM)  benefit codes (tariffs) will be added to the Manitoba Physician’s Manual. The exact tariff descriptions can be found here: www.gov.mb.ca/health/claims/docs/ccmtariff_2017.pdf.

We encourage physicians, billing staff and vendors interested in learning more about the requirements for billing these benefits to access the department’s CCM Tariff FAQ, and the Manitoba eHealth Home Clinic site.

- posted Nov. 23, 2016


Chronic Disease Management (CDM) Benefit Codes (tariffs)

The options for submitting your patient care treatment forms for general practitioners in fulfilling the requirements for billing benefit codes (tariffs) 8431, 8433, 8434 and 8435:

  1. Mail:  Paper copies of the completed Patient Care Treatment Forms can be mailed to the Claims Unit at 300 Carlton Street.
  2. Drop off:  Paper copies of the completed Patient Care Treatment Forms may be dropped off at 300 Carlton Street.
  3. Completion of the eForm:  The eForms can be completed on-line and electronically submitted directly to a secure government repository.  The eForm can be found at:  www.gov.mb.ca/health/primarycare/providers/chronicdisease/docs/patientcaretreatmentforms.pdf.
    The eForm user guide can be viewed at: www.gov.mb.ca/health/primarycare/providers/chronicdisease/docs/patientcaretreatmentforms_userguide.pdf
  4. EMR data extract:  General practitioners using a Manitoba-approved Electronic Medical Record (EMR) system may have the option of submitting the supporting information through a monthly data extract from their EMR, rather than completing the Patient Care Treatment Form to substantiate their claim.  This option is available to sites that have met the criteria for electronic submission and have been informed of this by Manitoba Health, Seniors and Active Living. For additional information regarding this option, please contact the PCIS office at 204-926-3482 or by email at PCISOffice@manitoba-ehealth.ca.

Regarding the submision of patient care treatment forms, click here.

Physicians are reminded that CDM benefit codes (tariffs) are payable only to the general practice physician who has provided the majority of the patient’s ongoing comprehensive care during the preceding twelve (12) months.

- revised March 2, 2017


After Hours Premiums for Designated Holidays Falling on a Saturday or Sunday

Pursuant to the Physician's Manual, After Hours Premiums on Designated Holidays include:

New Year's Day, Louis Riel Day, Good Friday, Easter Monday, Victoria Day, Canada Day, August Civic Holiday, Labour Day, Thanksgiving Day, Remembrance Day, Christmas Day and Boxing Day.

Consistent with the above, the designated holidays for 2017 are:

Monday, January 2, 2017
In lieu of January 1st, New Years Day
Monday, February 20, 2017
Louis Riel Day
Friday, April 14, 2017
Good Friday
Monday, April 17, 2017
Easter Monday
Monday, May 22, 2017
Victoria Day
Monday, July 3, 2017
In lieu of July 1st, Canada Day
Monday August 7, 2017
Civic Holiday
Monday, September 4, 2017
Labour Day
Monday, October 9, 2017
Thanksgiving Day
Monday, November 13, 2017
In lieu of November 11th, Remembrance Day
Monday, December 25, 2017
Christmas Day
Tuesday, December 26, 2017
Boxing Day
Monday, January 1, 2018 New Years Day

User ID and Access to Ireg

NOTE: On a quarterly basis, MHSAL shall conduct a review of potentially inactive user ID's.  User's who have not logged on for ninety consecutive days or more may have their user Id's deemed inactive at which time your user ID and access to Ireg may be deleted.   In order to regain access you will need to reapply. To obtain the necessary forms contact Practitioner Registry at 204-788-2567 or email practitionerregistry@gov.mb.ca.


Telelphone/Facsimile/Email Communications

BENEFIT CODE (TARIFF) 78005
Remarks are required re: benefit code (tariff) 78005. Please see pages B-8 to B-9 in the Physician’s Manual regarding the information required when billing this benefit code (tariff).  The time of day (in 24 hour format) must be entered in the start time field when billing this benefit code (tariff). Claims for benefit code (tariff) 78005 will be automatically rejected in the new CPS if submitted without a start time in the appropriate field.

BENEFIT CODE (TARIFF) 78000
Remarks are required re: benefit code (tariff) 78000. Please see pages B-6 to B-7 in the Physician’s Manual regarding the information required when billing this benefit code (tariff).  The time of day (in 24 hour format) must be entered in the start time field when billing this benefit code (tariff). Claims for benefit code (tariff) 78000 will be automatically rejected in the new CPS if submitted without a start time in the appropriate field.

BENEFIT CODE (TARIFF) 8001
According to Note 7) under benefit code (tariff) 8001 on page B-8 of the Physician’s Manual, when billing this benefit code (tariff), the claim must include the name of the Physician or RN (EP) who initiated the communication and the time of day the communication was completed.

The time of day (in 24 hour format) in the start time field and the billing number of the Physician or RN (EP) who initiated the communication in the referring doctor field is required when billing benefit code (tariff) 78001. Remarks are not required. Claims for benefit code (tariff) 78001 will be automatically rejected in the new CPS if submitted without a start time or a referring doctor number in the appropriate fields.


Transgender Health

The medical claims history maintained by Manitoba Health, Seniors and Active Living (MHSAL) is part of a patient’s Personal Health Information.  The accuracy of the claims history is paramount to ensuring that a patient’s records contain reliable information.  For this reason, claims for medical services that do not correspond with the patient’s gender are returned to the provider to request that the claim be reviewed to confirm the accuracy of the information submitted (e.g. to confirm that the correct family member was selected from the health card).

The submission of medical claims to MHSAL requires an International Classification of Disease (ICD) code associated with the patient’s medical condition or symptom, as well as the benefit catalogue items (Physician’s Manual tariffs) which identify the type of service a patient received (e.g. examination, procedure, etc.).  Some ICD codes and benefit (tariff) codes are gender specific, and accordingly, may be subject to initial refusal by the claims processing system if the gender identified on the patient’s health card does not correspond with a gender specific ICD or benefit (tariff) code.

In order to reduce the possibility of initial claim refusal, when you are submitting a claim with an ICD code or tariff that may be incongruous with the patient’s identified gender (for example, in relation to a service provided to a transgender patient), please contact the MHSAL Claims Unit at 204-786-7355.  By notifying the Claims Unit prior to submitting your initial claim for services provided to a transgender patient, you will assist MHSAL in ensuring that payment of all future claims for this patient are not delayed for this reason. 

Should you experience initial claim refusal because the ICD and/or benefit code (tariff) and the patient’s registered gender do not match, the claim may be resubmitted once the Claims Unit has been notified.


Lab Services for Northern Ontario Residents

Manitoba Health, Seniors and Active Living has been advised by OHIP that effective August 1, 2013, Manitoba physicians authorized to order lab services in Manitoba will now be able to order lab services in Ontario for Northern Ontario patients (Kenora and surrounding areas) without requiring an Ontario physician sign the requisition form.

All requests must be submitted on an Ontario laboratory requisition form which can be found on Ontario's website at:
http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/GetAttachDocs/014-4422-84~1/$File/4422-84.pdf

Any questions concerning this process may be directed to Ontario at interprovincebilling.moh@ontario.ca.


Interprovincial Health Insurance Agreements Coordinating Committee (IHIACC) Bulletins