Payment for your claim was reduced or refused in accordance with the applicable benefits schedule. To view the benefits schedules, go to the Alberta Health website at https://www.alberta.ca/health-wellness.aspx.
Before you begin, have handy other codes that you may have billed for this patient on the same date of service or within the inclusive care period.
Using the Health Service Code search feature, enter in the HSC that you received this explanatory code for. Once the code appears, review the Governing Rules to determine if this code breaks any of the rules that are listed. If yes, determine if the rules make sense in the situation that you are billing for. If they do, you may have to delete the claim and accept that the rules have been applied appropriately. If the rules still do not make sense, review the other codes that were billed for the patient on the same date of service and determine if any of the rules were applied in error. If yes, please contact Alberta Health at 780.422.1600.
