Explore our FAQ
The long-awaited Primary Care Physician Compensation Model (PCPCM) has officially been announced and will be implemented in April 2025. Scroll down to review the FAQ or explore the questions by theme using the buttons below. We will continue to update this page as new program details emerge and your most frequently asked questions are answered.
QUICK LINKS
You will receive an email from the Alberta Medical Association with a copy of the Ministerial Order for your records and the PCPCM application form PCN14743 Rev. 2025-02.
Please follow the steps in this email and submit the requested information back to Alberta Health.
After your application is received you will have notification of submission emailed to you from Alberta Health.
You will receive an email from Alberta Health indicating the date your application was received. Applications will be forwarded for processing. Once generated, a letter will be mailed out to you containing your PCPCM Business Arrangement number.
The copy of the Ministerial Order you received as a secondary attachment titled MO50_2025 PCPCM Feb 20 2025 3.pdf is for your personal records and does not require filling out.
The PCPCM Clinic ARP Attestation/ Declaration required for Alberta Health’s records is on form PCN14743 Rev. 2025-02 Section D of the PCPCM - Application attachment as seen below:
Please ensure you have the most up to date version of the application form (PCN14743 Rev. 2025-02 in the bottom left corner of the document.)
A number of physicians have reached out with challenges. Please see this troubleshooting resource How to use PCPCM PDF Forms
Please ensure you are filling out the correct version of the application form sent via email on or after 10 p.m. February 24, 2025. This is the most up to date version. It will have the form number PCN14743 Rev. 2025-02 in the bottom left of the document.
If you are having difficulty entering text to certain fields the appropriate check box above the area may not have been selected.
This opens the text fields to be edited.
Or you may be trying to fill out the Ministerial Order copy intended for your personal records and need to open the form PCN14743 Rev. 2025-02.
You will need to attach a void cheque or official banking direct deposit documentation.
Please submit your application to [email protected] when completed.
Please do not cc the PCPCM inbox in this email.
The Submitter ULI and Submitter Prefix Code are provided by H-Link, to physicians, or the person/organization who submits claims on their behalf. The Submitter ULI is a 9-digit number that is different from your Prac ID number. The Submitter Prefix Code contains three alpha-characters. This identifier is attached to your billing and claims documentation, you will likely find your Submitter Prefix on your Statement of Assessment documentation.
Claims are submitted electronically using H-Link electronic claims system
Here is the Physician Resource Guide with additional information on Alberta Health’s website.
If you still can’t locate this information you may want to reach out to H-Link, or your accredited submitter attached to your Fee- for Service Business Arrangement.
If a physician wants their payment sent to the clinic, they can check either the ‘Practitioner’ or ‘Professional Corporation’ box under Section C. If the physician has a Prof Corp, include the legal name. Include the banking information for the clinic below. This does not need to match the banking information on your Prof Corp. It is advisable for clinics to contact an accountant that has a good understanding of their specific structure for further advice.
If you are not able to attach the void cheque or official bank deposit documentation to the PDF, Alberta Health has advised that physicians send the void cheque or financial institution documentation in a separate email to [email protected], indicating their full name, email and type of information attached in the body of the email.
The Practitioner Identification number is a unique nine-digit code, assigned by Alberta Health to individual practitioners. This number can be found on your Statement of Assessment or in your EMR provider configuration details.
Please use this resource to locate your Facility ID | AMA in your EMR. You can submit your WDFA as an alternative. This information is located in your Netcare “My Details”
Please use this resource to find your CPAR Panel ID | AMA . Alternatively, you can contact your CII/CPAR Panel Administrator for assistance.
The AMA does not have up to date information on application status and processing. Alberta Health will send a ‘Confirmation of Application’ receipt to the physician after the application has been reviewed. It is expected to have a couple days delay.
The Ministerial Order defines "off-loading" as shifting care for paneled patients to fee-for-service physicians when the primary physician could have reasonably provided that care. The key consideration here is what is reasonable in the given context.
For example, having a locum available for same-day, more urgent visits seems reasonable. However, if a locum is routinely seeing the same overflow patients, it may be important to assess whether panel size and demand are impacting access.
The AMA has several dedicated tools and resources that will help determine if the PCPCM is appropriate for their practice style and will result in increased compensation. Joining the PCPCM is a choice made by an individual physician.
Existing compensation agreements will not go away – the PCPCM will join these models as another option for physician compensation in Alberta. See our Compensation Model Comparison resource
The PCPCM represents a hybrid between Alberta’s default Fee-For-Service funding model (encounter payments), clinical ARPs (time payment) and capitation (panel and patient complexity-based payment).
Total compensation under the PCPCM includes:
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patient encounters
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time spent on direct patient care, indirect care and practice management
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complexity adjusted panel payments
Compensation is provided to individual physicians and will depend on several factors, including patient panel size, the complexity of the physician's paneled patients and time spent on both direct and indirect care. The PCPCM Financial Calculator will help AMA Members and Clinic Managers Network members estimate potential earnings.
The anticipated increase in annual income is estimated to be approximately 25% more for the average full-time family physician practicing longitudinal care. The actual increase for each physician may vary.
AMA Members and Clinic Managers can utilize AMA's Financial Calculator (login required) to provide a daily or weekly estimate based on an individual physician's practice characteristics.
No. The PCPCM is a new compensation option for family physicians and rural generalists who feel it suits their practice and community needs, offering expanded physician choice.
Physicians can continue using the Fee-For-Service model or other clinical alternative relationship plans (cARPs).
In the next month or two, we expect to have updated SOMB rates for the 2024-25 allocation year (1.48% overall for family medicine) and a retroactive payment to recognize the delay in implementing these increases.
The 2025-26 fee allocation is currently unknown, as it will depend upon the Market Rate Review (currently underway) and reopener negotiations with the government. The AMA and Section of Family Medicine are committed to having competitive fee-for-service rates, as it’s recognized that the new PCPCM model does not fit all practice types.
Yes. This model was known previously as the Physician Comprehensive Care Model (PCCM) for primary care and is now called the Primary Care Physician Compensation Model (PCPCM).
Services claimed under a PCPCM BA, including time, follow the same payment distribution schedule as claims submitted under a FFS BA. Rules regarding claims submission, processing and timelines remain the same as FFS.
Panel payments will be paid retrospectively on a monthly basis.
Sign-up for our PCPCM In-Progress Newsletter for regular updates from the AMA on new resources, model updates and support.
NEW: On March 5, 2025, an updated version of the PCPCM Operations Manual was published.
To be eligible, physicians must
- participate in CII/CPAR
- have a minimum PCPCM panel size of 500 - learn how this is calculated
- work 400 hours of service over 40 weeks of the year
To understand the full eligibility requirements, please see the PCPCM Operations Manual.
Calculating your ideal panel size is a good first step in determining how you approach panel growth. For more information, visit the AMA's Enhanced Access Resources webpage.
Growing your patient panel is a decision that should be made with broader considerations like patient access, effective care and workload management. Several resources are available from the AMA to support this, including our EMR Resources, CII/CPAR Resources and PCPCM Panel Calculation.
Additional resources written by physicians include The American Academy of Family Physicians (AAFP)’s Panel Size: How Many Patients Can One Doctor Manage and the Alberta College of Family Physicians’ Building a Patient Panel: Meet and Greets.
As panel size increases, the demand for appointments will also increase, which can lead to longer delays for appointments. Metrics like Third Next Available Appointment (TNA) can be useful in monitoring access as a panel grows.
Yes. We recommend that physicians who are not yet on CII/CPAR start the enrolment process as soon as possible.
CPAR will be used as the source of truth to determine the patients paneled to each physician for the purposes of the panel payment component of the PCPCM.
To learn more about CII/CPAR, including how you can access the CII/CPAR Acceleration Grant, visit AMA's CII/CPAR webpage.
No. Actively paneling in CPAR is a pre-requisite to joining PCPCM. Alberta Health has committed additional resources to support CPAR onboarding for PCPCM. For those physicians who have completed the Confirmation of Participation Form for CPAR already, it is important to respond promptly to eHealth requests to minimize the time it takes to go live.
To learn more about CII/CPAR, including how you can access the CII/CPAR Acceleration Grant, visit AMA's CII/CPAR webpage.
Yes. Rural generalists qualify for PCPCM if they meet the eligibility criteria.
For rural generalists whose practice involves providing a portion of services in rural health facilities, the PCPCM will address only the community clinic portion of their practice. Further discussions and action is required to address other elements of rural generalist practices and is an area of ongoing discussion with Alberta Health.
Physicians who provide services in health facilities may also benefit from the elements included in the AMA’s Acute Care Stabilization Proposal.
No. Nurse practitioners and other health care providers are not eligible for compensation or funding under the PCPCM. This model has been created exclusively for family physicians and rural generalists.
The PCPCM is intended for use by Family Medicine and Rural Generalist physicians providing life-long longitudinal care for patients. Claims under PCPCM are submitted using the GP skill code.
If a physician’s panel size drops below the minimum, the physician will have 12 weeks to bring their PCPCM panel back up to 500. It is expected that physicians, or their teams, review CPAR reports on a monthly basis.
Alberta Health is exploring the option of including total PCPCM panel size on a report to enrolled physicians.
Enrollment in the PCPCM has begun! Learn more.
No. Joining the PCPCM is a decision to be made by the individual physician. Other remuneration models, including fee for service, ARP, and blended capitation will still be available.
Yes. Physicians can withdraw from the PCPCM model by notifying the Ministry of Health with at least 30 days' written notice. The forms for pausing and withdrawing from the model will be shared in early 2025.
Yes. If you choose to leave the PCPCM you may apply to re-enroll twelve months after departing the model.
For encounters, a single basket of Health Service Codes, typically billed by longitudinal family physicians for visits and procedures, has been defined in the PCPCM and are referred to as in-basket codes. In-basket codes will be paid at a rate of 68.5% of FFS value.
Health Service Codes not defined in the list of in-basket codes are considered out-of-basket but are eligible to be billed at 100% FFS value.
In addition to your encounter payments, family physicians will bill an hourly rate for direct and indirect patient care at $105 per hour.
Physicians offering appointments in clinic after-hours and on weekends can bill for direct care time at a premium of $87.72 per hour, for a combined total of $192.72 per hour.
For clinic practice management, physicians will be compensated an additional 10% of their total hours billed for direct and indirect care multiplied by a rate of $105 per hour. This is paid automatically based on the time claimed.
For panel payments, the average annual payment per paneled patient is $70.25 and can range from $32.87 - $136.73 depending on the patient’s age, sex and complexity.
No. There is no maximum or ceiling for physician earnings under a PCPCM Business Arrangement Number (PCCM BA).
The PCPCM uses existing fee-for-service (FFS) Health Service Codes (HSC). Approximately 94% of HSCs used by community Family Medicine are included under the PCCM and these HSCs are referred to as “in-basket.” Information about the Fee Codes can be found here.
Any Health Service Codes billable by a family physician or rural generalist, not defined in the list of in-basket codes, are considered out-of-basket.
While operating under the PCPCM BA, these out-of basket Health Service Codes will be billed using the physician's PCPCM BA. The discount will not be applied and will be paid at 100% FFS value. As these codes are paid at 100% FFS value, time spent providing an out-of-basket service cannot be claimed.
For patients within facilities such as hospital, long term care and designated assisted living, Health Service Codes should be billed using the physician’s FFS BA. These codes will be paid at 100% FFS value.
Complexity is determined using the patient's age, sex and the CIHI Population Grouper which categorizes patients based on their age, sex, diagnoses and use of the entire health system. It is anticipated that the average annual payment per patient will be $70.25.
The panel payment component of the PCCM is provided for each patient who is attached to a family physician's panel (and reflected in CPAR). A physician’s average panel complexity payment per patient can be viewed in their AMA Member Dashboard. Keep in mind that the complexity value is retrospective, and there will be lag time as patient complexity changes.
CIHI’s Population Grouping Methodology (POP Grouper) builds clinical and demographic profiles for each person in a population. These profiles help predict the population’s health care needs and costs. More information can be found on the CIHI website or in their Condensed Methodology Notes here.
At this time, there is no appeal process for complexity assignments.
Business Costs Program (BCP) payments are not billable or payable under the PCPCM.
The encounter component of the PCPCM is eligible for Rural Remote Northern Program (RRNP) payments. For the purposes of calculating the RRNP payment, encounter rates are valued at 100% of their FFS values.
Please note, the RRNP is currently under Alberta Health review.
No. Complexity modifiers are not billable or payable under the PCPCM.
Three main factors determine your PCPCM Panel Size Calculation:
- EMR Panel Size & Processes
- CPAR Panel Size
- Out-of-Province Patients
It depends. If you plan to use your PCPCM BA at multiple locations, your panel size will be combined for one panel payment.
The panels will not be combined if you operate under different funding models at each location.
There will be no negation under the PCPCM if your paneled patient seeks services from another physician. The AMA advocated strongly against including negation in this model, and Alberta Health agreed.
For Alberta physicians who practice near other provincial borders, you cannot submit claims through PCPCM for patients who do not have an Alberta Health Care Card.
Patients who do not have an Alberta Health Care Card will not be counted toward your panel for PCPCM.
When operating under the PCPCM, the physician's PCPCM BA should always be used, and time can be claimed for all in-basket services. This includes claiming services and time when providing care to both paneled and non-paneled patients, so long as they are the minority.
If a physician is hosting a walk-in clinic for a dedicated portion of the day, where the majority of patients seen are not paneled to the current provider, they must switch to FFS billing.
Time-based codes cannot be billed when providing out-of-basket services, which are paid at 100% FFS value, or when providing uninsured services, whether those patients are paneled or not.
For locum physicians and host physicians, the rules for PCPCM vary depending on the length of coverage. More information for locum scenarios is coming soon.
Diagnostic codes are one of the factors considered for patient complexity.
If a patient has a chronic disease, entering that information will be reflected in future CIHI updates. It is still encouraged to enter the appropriate diagnostic codes when you see the patient, just as you do with fee-for-service.
Panel payments are made for all patients on your PCPCM panel retrospectively on a monthly basis. The yearly dollar amount per patient is calculated and divided by 12 to determine monthly payments. This payment includes all patients who are on your PCPCM panel, even if they are not seen in this time frame.
The reporting system is based on data from all provinces, which report to CIHI on patient health status. It is measured and triggered by patient interactions with not just the primary care system, but also the acute care system, including hospitalizations, emergency department visits, and long-term care visits. Multiple factors contribute to the triggers, and it is not necessarily a single event that activates it. The Ontario Medical Association has made available to the AMA learning modules on CIHI’s Population Grouping Methodology. To request this resource please use the PCPCM General Inquiry & Feedback Form | AMA
No. The PCPCM offers compensation to an individual physician and does not fund care provided by other practitioners.
While attendance at our virtual Information Sessions is restricted to AMA Member Physicians, recordings are available the next day on our website - no login required. These information sessions feature live Q&As and valuable information from physician leaders.
Announcement: Clinic teams are invited to our new Live & On Call with AMA sessions. Every Friday in February, join AMA-ACTT from 12:30 - 1:30 p.m.
New: Members of AMA's Clinic Managers Network now have access to our PCPCM Financial Calculators. Watch your inbox for instructions on how to obtain an AMA website login.
Most EMRs do not have a reliable time tracking system. Please consult with your vendor to determine if they offer such a feature.