What is Service Event Reporting?
Service Event Reporting (SER), or shadow billing, is a Primary and Preventative Health Services (PPHS) accountability tool which requires participating cARP physicians to submit claims reporting using Schedule of Medical Benefit (SOMB) codes and cARP Service Codes (S-codes).
SER provides PPHS with a complete picture of program services delivered through the cARP, serving as the official record for compensated services.
The claims process is similar to billing in fee-for-service (FFS), except that a cARP BA number is used to capture activity for the entire program. Medically insured services that fall outside the scope of the cARP must be billed by each physician through their FFS BA.
PPHS issues SER summaries on the Statement of Assessment each month. If PPHS does not receive physician claims, the Minister may withhold future program funding.
For more information, see Section 2.5 of AMA's annualized cARP Implementation Guide and the ARP 3 Alberta Government Bulletin. For guidance, please contact [email protected].
Key Requirements
SER is mandatory under the annualized cARP Program Parameters Ministerial Order.
- Claims must be submitted within 90 days of the service or activity
- Rejected claims must be corrected within 90 days of appearing on the Statement of Assessment
SER also supports the recovery of claims documentation during a PPHS audit.
Physician Benefit Programs
- SER is required for Business Cost Program (BCP), Rural, Remote, Northern Program (RRNP) payments
- 03.01AA codes must be claimed in conjunction with HSCs for patient-specific clinical services. At this time, only family medicine physicians who provide regularly scheduled after-hours care within facilities are eligible.
Impact on Program Funding & Expansion Requests
Complete and accurate SER reporting is important for demonstrating program accountability and is a key component to justify program expansion requests. Attending an AMA Billing Seminar is recommended to clarify the process. These sessions can be attended by groups of five or more AMA member physicians and their billing teams.
Declining SER volumes may be interpreted by PPHS as reduced efficiency, which can result in delayed funding, rejection of funding expansion requests and trigger funding evaluations and audits.
SER also influences broader funding analyses and micro-allocation decisions because the data can help determine which section(s) “own” specific HSCs based on how frequently each section bills those codes. It can also support system‑level analyses related to particular diseases. For example, diagnosis codes feed into the Canadian Institute for Health Information (CIHI) Population Grouping Methodology (POP Grouper), which is used to adjust patient complexity in PCPCM panel‑based payments and can be applied to support forecasting of future health‑system needs.
Best Practices
Submit full and complete SER for all services and establish internal processes to:
- educate participating physicians on legal requirements
- educate participating physicians on individual liabilities within internal governance agreements
- regularly monitor service volume
- enforce timely submissions of claims
- ensure claims support any eligible 03.01AA premiums
cARP Service Codes
cARP S-codes ensure that physicians are compensated for time spent delivering medically insured services indirectly on the patient’s behalf.
All S-codes are claimed per 5 minutes and require documentation to be made available upon request. For codes not bulk-claimed with a non-patient ULI, use the patient’s ULI and document time and claim details in the patient’s record. Authorized Representatives ARs can request a non-patient-specific ULI from their PPHS analyst during implementation.
S001
Time spent researching specific diagnoses or treatments related to the care of a complex patient
WHEN TO USE
- Claimed any day prior to the day the patient is seen
CANNOT BE USED FOR
- Academic research
- On the day a patient is seen, due to available SOMB codes
REQUIREMENTS
- Documentation of time and claim in the patient's record
- Claim using patient-specific ULI
S002
Time spent waiting for a patient who did not attend a scheduled appointment
WHEN TO USE
- Unattended appointments not filled by another patient or other clinical activities
CANNOT BE USED FOR
- No-shows or cancellations where the physician's time was repurposed for SOMB or S-code work (where no waiting occurred)
- Appointments where time is filled by another patient
REQUIREMENTS
- The physician must have been at the Centre
S003
Time spent waiting for drop-in patients.
WHEN TO USE
- Claim up to the time specified in the cARP Conditions of Payment (COP) - Schedule A, Article 3
REQUIREMENTS
- Requires special permission from PPHS
- Claim using non-patient-specific ULI
- Details related to time claimed must be documented and made available upon request
S004
Any communication, including but not limited to informal, non-scheduled discussions, meetings, interviews and conferences with a physician, allied health professional, school, agency, board, committee or relative regarding advice or care of a patient.
WHEN TO USE
- Discussing a specific patient
- Does not matter who initiates the conversation
CANNOT BE USED
- When SOMB codes apply
REQUIREMENTS
- Documentation of time and claim in the patient's record
- Claim using patient-specific ULI
- Electronic communications must meet CPSA guidelines
- A Privacy Impact Assessment (PIA) must be submitted to the Office of the Privacy Commissioner of Alberta
S005
Any communication, including but not limited to informal, non-scheduled discussions, meetings, interviews and conferences with a physician, allied health professional, school, agency, board, committee or relative regarding advice or care of a patient
WHEN TO USE
- Discussion regarding multiple patients (e.g., bulk billing, case conferences)
- Electronic communications must meet CPSA guidelines
- A Privacy Impact Assessment (PIA) must be submitted to the Office of the Privacy Commissioner of Alberta
REQUIREMENTS
- Discussion must be documented and made available upon request
- Claim using non-patient-specific ULI
S006
Second physician at a patient visit
WHEN TO USE
- Only the second physician involved in shared patient care services can claim
REQUIREMENTS
- Requires special permission from PPHS
- Physician directly involved in the patient’s care must claim SOMB HSCs
- The patient must be present with at least one of the physicians involved
- Documentation of time and claim in the patient's record
- Claim using patient-specific ULI
S007
Time spent delivering program services to a patient who is a resident of Alberta but not enroled in the Alberta Health Care Insurance Plan (AHCIP)
WHEN TO USE
- When an Alberta resident is eligible but not enroled in AHCIP
REQUIREMENTS
- Requires special permission from PPHS
- Details regarding services delivered must be documented and made available upon request
- Claim using non-patient-specific ULI
S008
Group health education session
WHEN TO USE
- Session delivered to members of the public or non-program patients for a topic related to cARP program services
CANNOT BE USED FOR
- Sessions delivered to other providers
- Lecture-based teaching
- Preparation time
REQUIREMENTS
- Details regarding services delivered must be documented and made available upon request
- Claim using non-patient-specific ULI
S009
Report writing and other clinical documentation related to the care and treatment of a patient.
WHEN TO USE
- Any day after a patient visit
- Same day as patient visit, if time allowed via SOMB is exceeded
REQUIREMENTS
- Documentation of time and claim in the patient's record
- Claim using patient-specific ULI
S010
Review of patient lab results, consultant reports or other care reports.
WHEN TO USE
- Any day after a patient visit
- Same day as patient visit, if the time specified by complexity modifier is exceeded
REQUIREMENTS
- Documentation of time and claim in the patient's record
- Claim using patient-specific ULI
S011
Review of patient lab results, consultant reports or other care reports for multiple patients.
WHEN TO USE
- Reviewing reports
- Bulk billing
REQUIREMENTS
- Details regarding services delivered must be documented and made available upon request
- Claim using non-patient-specific ULI
S012
Time spent for work related to cARP business, including but not limited to reporting, completing Letters of Participation (LOPs) or Letters of Termination (LOTs), cARP applications, meetings with PPHS, health service delivery organizations (HSDOs) or the AMA regarding cARP development.
WHEN TO USE
- Only the designated Authorized Representative (AR) can claim
CANNOT BE USED FOR
- Physician group meetings not directly related to cARP development
- Time claims when the AR is paid for other services
REQUIREMENTS
- Details regarding time claimed must be documented and made available upon request
- Claim using non-patient-specific ULI