Enrolling with the Medical Services Plan
» Eligibility
» Assignment of a Billing Number
» New Physicians or Physicians Relocating to B.C.
» Change of Address or Licence
» De-enrollment and Opting Out
» Notifying Patients
Eligibility
The following practitioners are eligible to enroll with MSP and obtain MSP billing numbers:
Enrollment status, and, therefore, the possession of an active billing number, is contingent upon the practitioner's continued licensure by the appropriate licensing body. Any change in licensure, such as the renewal of a temporary license or specialty, must be reported to MSP to avoid refusal of claims.
Assignment of a Billing Number
Each practitioner enrolled with MSP is assigned a billing number consisting of two numbers:
- a practitioner number, which identifies the practitioner rendering the service, and
- a payment number, which identifies the person or group (e.g. clinic, hospital) to which payment is to be made.
The practitioner and payment numbers are usually the same. However, they differ in cases where a practitioner designates another practitioner or a group, such as a clinic or hospital, to receive that practitioner's MSP fee-for-service payments. See Assignment of Payment.
All claims submitted to MSP must include the practitioner number of the practitioner who performed the service; therefore, a practitioner cannot bill under another practitioner's number. The practitioner whose number appears on the MSP claim assumes full responsibility for the service provided.
To apply for an MSP billing number:
New Physicians or Physicians Relocating to B.C.
Physicians wishing to obtain a billing number from MSP must follow a clearly defined process. You must first request licensure from the College of Physicians and Surgeons prior to requesting a MSP billing number. The telephone number for the College is 604 733-7758. For more information, contact Provider Services.
Change of Address or Licence
If you change your address or telephone number, or if there is a change in your specialty or licence status, advise MSP so that your records can be updated accordingly. Timely notification of changes enables MSP to provide practitioners with accurate and efficient service and helps prevent unnecessary refusal of claims.
De-enrollment and Opting out
A medical or health care practitioner may:
- enroll with MSP (if licensed with the appropriate licensing body); or
- once enrolled, opt out of MSP; or
- once enrolled, de-enroll from MSP (cancel the enrolment); or
- not enroll with MSP.
Enrolled Physicians
Licensed physicians who register with MSP are called "enrolled" physicians. Enrolled physicians may choose to be "opted-in" or "opted-out".
Opted-in physicians are physicians who are enrolled in MSP under Section 13 of the Medicare Protection Act and who elect to bill MSP directly for insured services provided to MSP beneficiaries. An opted in physician may not bill a patient directly for an insured benefit.
Opted-out physicians are physicians who are enrolled in MSP under Section 13 of the Medicare Protection Act and who elect to bill patients directly for insured benefits. The patient may then claim reimbursement from MSP. By law, an opted-out physician may not charge a patient more for an insured benefit than the prescribed MSP amount.
Physicians Who Are Not Enrolled
Unenrolled physicians are not registered with MSP. Consequently, services provided by a physician who is not enrolled or whose enrollment has been cancelled with MSP are not insured and are not reimbursed by MSP. By law, unenrolled physicians in B.C. may not charge patients more than the MSP amount for an insured benefit, unless the service is provided at a facility other than a hospital or community care facility, as defined by legislation.
Note: The prohibition of extra-billing for medical services does not apply to uninsured services such as cosmetic surgery, third-party medical services, etc. The charges for these uninsured services, including related pre-operative and post-operative visits, are to be paid by the patient.
Enrolled Supplementary Benefit Practitioners
Licensed health care practitioners who register with MSP are called "enrolled" practitioners. Enrolled practitioners may choose to be "opted-in" or "opted-out".
Opted-in practitioners must bill MSP directly for all required services provided to MSP beneficiaries. Opted-in practitioners are prohibited by legislation from charging MSP beneficiaries more than the amount paid by MSP for an MSP-insured service.
Opted-out practitioners have elected to bill patients directly for insured services. Although opted-out practitioners may choose to submit claims to MSP on behalf of patients who are MSP beneficiaries, MSP reimburses the beneficiaries directly for those insured services.
Supplementary Benefit Practitioners Who Are Not Enrolled
The services of a non-enrolled or de-enrolled supplementary health care practitioner are not benefits of MSP. These services can be billed directly to the patient for an amount more than that set in the appropriate MSP payment schedule, provided the patient is advised of the practitioner's payment protocol before the service is rendered.
Notifying Patients
If a medical or health care practitioner intends to require their patients to pay all or a portion of the costs of a service, he or she must inform the patient, prior to rendering the service:
- that the patient will be required to pay part or all of the cost directly;
- the amount the patient will be required to pay; and
- the amount the patient can expect to be reimbursed by MSP.
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Last Revised: December 20, 2007
