Explore our FAQ
Scroll down or explore the questions by theme using the buttons in the sidebar. AMA will continue to update this page as new program details emerge and your most frequently asked questions are answered - check back often!
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:
-
patient encounters
-
time spent on direct patient care, indirect care and practice management
-
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 panel and time spent on both direct and indirect care. For more details and rates, see our Billing Basics Guide and Payment Schedule.
The estimated increase in annual income is 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.
There is no maximum on physician earnings; however, the after-hours premium has limitations.
A maximum of 20% of total claimed time can be during premium rate hours over the course of a fiscal year that runs from April through March. Physicians are expected to monitor hours claimed with the premium rate throughout the fiscal year to ensure compliance.
The PCPCM is for family medicine physicians and rural generalists who provide longitudinal care to a defined panel of patients. To get access to the PCPCM application, physicians must:
- participate in CII/CPAR
- have a minimum PCPCM panel size of 500
- work 400 hours of service over 40 weeks of the year
For full eligibility requirements, 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 Enhanced Access Resources.
Growing your 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 and CII/CPAR Resources.
As panels grow, demand for appointments will also increase, which can increase wait times. Third Next Available Appointment (TNA) metrics can be useful in monitoring access as a panel grows.
Additional physician-authored resources:
- Panel Size: How Many Patients Can One Doctor Manage
- Alberta College of Family Physicians’ Building a Patient Panel: Meet and Greets.
Yes, rural generalists qualify for PCPCM. To be eligible for PCPCM, all physicians, including rural generalists, must provide community-based services to a minimum of 500 paneled patients and meet PCPCM eligibility requirements. Physicians also retain their ability to claim services for non-paneled patients through an existing FFS BA. This ensures physicians who want to join the PCPCM can continue to offer services in AHS facilities, walk-in clinics and other facilities, such as long-term care and designated assisted living.
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 value.
Note: RRNP is currently under review by Primary and Preventative Health Services.
The PCPCM is intended for use by family medicine and rural generalist physicians providing longitudinal care for patients. Claims under PCPCM must be submitted using the GP skill code.
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.
Physicians must be live on CII/CPAR before applying. Once the CPAR Confirmation of Participation Form has been submitted, physicians should respond promptly to eHealth requests to minimize the time it takes to go live.
Three main factors determine your PCPCM Panel Size Calculation:
- EMR Panel Size & Processes
- CPAR Panel Size
- Out-of-Province Patients
Physicians will have 12 weeks to bring their panel back up to 500 and remain on the model. After this grace period, should the physician's panel remain below 500, their PCPCM BA will be terminated. After 12 months, the physician can reapply to join the model.
Physicians whose panel drops below 500 will receive an email from PPHS with their PCPCM panel size and information about when their panel must reach 500 to remain on the model.
There are several ways to grow and monitor PCPCM panels, including:
- Review CPAR reports every month - ensure patients are appropriately paneled and attachment errors are corrected before the EMR uploads to CPAR.
- A new CPAR Report, Panel Submission Metrics, displays details about the last six months of panel submissions including the number of patients uploaded from the EMR, demographic mismatches, attachment errors, total active attachments and Conflicts.
- Accept new patients - tips for sustainable and responsible panel growth can be found here
Physicians or their teams are expected to review their PCPCM panel size and CPAR reports on panel conflicts and demographic mismatches monthly. For more information, see Section 6.4 of the Operations Manual and our FAQ for increasing your panel size.
PCPCM BAs will be linked to a single submitter ID. Physicians who practice out of two independent clinics and submit CPAR panels from each will need to manage both panels under a single PCPCM BA and submitter.
Combining separate CPAR panel numbers under one single CPAR Panel number should only be done in situations where PCPCM will be billed from both clinics, for example, when the same EMR and submitter information are used at both locations.
If managing more than one clinic under a single PCPCM BA does not work, consider which clinic has the larger CPAR panel size and attach the PCPCM business arrangement to that clinic. Become an independent submitter, choose which clinic and CPAR panel will be linked to the PCPCM BA, and continue using Fee for Service out of the other clinic.
Physicians can enroll in the PCPCM at any time. Information on monthly deadlines and corresponding start dates can be found in the March 24 Alberta Government Bulletin.
Physicians will receive an email from the Alberta Medical Association containing a copy of the Ministerial Order for your records and the PCPCM application form PCN14743 Rev. 2025-02.
Follow the steps in the email and return the requested information to Primary and Preventative Health Services. If you need help opening the PDF and completing the application, detailed information is available on our Application support page.
Physicians will receive an email from Primary and Preventative Health Services indicating the date their application was received. Once processed and approved, their PCPCM Business Arrangement (BA) Number will be mailed to the clinic address listed on the application.
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).
The application must be opened using Adobe. For technical troubleshooting and support finding form requirements, see our Application Support Guide.
Once your PCPCM Application is approved and you receive your PCPCM BA, you must start working in the model immediately. The Ministerial Order rules are in effect on the date identified on your PCPCM BA.
Physicians are welcome to submit an Expression of Interest and hold off on their application until they are ready to join formally.
The PCPCM Ministerial Order rules (login required) are in effect. To stay compliant and begin billing with your new BA, here's what you need to know:
- Panel Payments reflect the CPAR upload from the previous month (e.g., Panel payment in July is for the CPAR uploads in June).
- Billing - Option A: Time and encounter billing can begin with your PCPCM BA. Ensure you've set up a "fake patient" record for time in your EMR.
- Billing - Option B: Billing for time and encounters can be delayed until your EMR system is fully set up. Claims must be submitted within 90 days of the service date.
- FFS BA Usage: Your existing FFS BA remains available for use with non-PCPCM paneled patients.
Contact your EMR provider for additional BA and billing support. AMA will continue to provide updates as new information from vendors becomes available.
Additional Resources
The Ministerial Order (AMA login required) defines off-loading as shifting care for paneled patients to fee-for-service physicians when the primary PCPCM 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 is 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.
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 information on claim deadlines, Primary and Preventative Health Services processing schedule and anticipated payment, see our PCPCM Payment Schedule resource.
Claim submission for PCPCM largely follows the same process as Fee for Service. Under PCPCM, however, time must be claimed for each day consecutively using a non-patient-specific ULI. For more information, see:
- Operations Manual, section 5.3, Submitting Claims for Time-Based Codes
- Billing Basics
- Payment Schedule
- Billing for Time by EMR
Please see our resource, Billing for Time by EMR.
Sample statements are available in Section 5.1 and Section 6.2 of the PCPCM Operations Manual.
Primary and Primary Health Services (the Ministry) sends statements to the physician's business mailing address on file and linked to their PRAC ID.
If your address has changed
Complete Notification of Business Address Change (AHC11459) form. Visit Health professional business forms | Alberta.ca
Redirecting statements to a different address
To redirect statements for a specific BA number:
- Download Business Arrangement and Relationships Application (AHC11236) from the same website.
- In the Registration Type box, select Business Arrangement Request.
- The form will expand. Under Identification of the BA Contract Holder, fill in the required details. Note: Submit a separate request for each BA number.
- In the Create, Change, or End BA section, select Change where my statements are sent.
- The form will expand again. Enter:
- The BA number you wish to update.
- Under Send Statement of Account and Statement of Assessment, select My PC/Clinic.
- Provide the name and address where the Ministry will send statements.
- Save and print the form. Contract holder signs (signature box at the bottom).
Returned statements
- The Ministry will resend statements returned due to an outdated address via Canada Post once updated address is complete.
- Urgent Requests
- If you require information from statements urgently, refer to the Important Information section on the Request for Statement of Account/Assessment (AHC0002) for alternative access methods.
Contact Information
- Submit completed forms to: [email protected]
- Program inquiries: [email protected]
As with Fee-for-Service, claims to the Alberta Health Care Insurance Plan can be submitted when your EMR is set up. Just ensure you submit no more than 90 days after the health service was provided. To learn more about setting up your EMR, see our Billing for Time by EMR Guide.
If you are unsure about the vendor's timeline for updating your EMR for PCPCM, we suggest you reach out directly for support.
Most EMRs do not have a reliable time-tracking system. We suggest you consult with your vendor to determine their best approach.
For a manual time-tracking template, see our Sample Day Sheet resource.
The non-patient-specific unique lifetime identifier (ULI) is 10814-7612.
Codes are PC001, PC002, PC003, and PC004.
More information is available in the Operations Manual: Section 5.3: Submitting Claims for Time Under the PCPCM.
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.
On January 9, 2026, version 4.2 of the PCPCM Operations Manual was published.
Sign up for the PCPCM In-Progress Newsletter for updates on new resources, model rules and support from AMA-ACTT. This newsletter is issued every 1-3 months.
The PCPCM uses existing fee-for-service (FFS) Health Service Codes. Approximately 94% of HSCs used by family medicine physicians are included and are referred to as “in-basket codes.”
More information can be found here.
No. Complexity modifiers are not billable or payable under the PCPCM.
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.
Panel payments are made retrospectively for patients on your PCPCM panel every month.
The yearly dollar amount per patient is calculated and divided by 12 to determine monthly payments. This payment includes all patients on your PCPCM panel, regardless if they've been seen at the clinic that month.
See our Complexity-Adjusted Panel Payments resource and PCPCM Payment Schedule for more information.
For information on EMR uploads, Primary and Preventative Health Services processing and anticipated payment timelines, see our PCPCM Payment Schedule resource.
The physician's PCPCM BA should always be used and time can be claimed for in-basket services. This includes claiming services and time when providing care to non-paneled patients, so long as paneled patients make up the majority of encounters.
If hosting a walk-in clinic for a dedicated portion of the day physicians must switch to FFS billing.
Time-based codes cannot be billed when providing out-of-basket or uninsured services, whether those patients are paneled or not.
Patients without a valid Alberta health care coverage card, but with a valid health care card from another province or territory, do not count toward your PCPCM panel.
When these patients are seen during time dedicated to seeing mostly paneled patients, you can claim the encounter and time with your PCPCM BA.
If these patients are seen during a dedicated walk-in clinic day, claims must be submitted using your Fee-for-Service BA.
No. The PCPCM offers compensation to an individual physician and does not fund care provided by other practitioners.
Our PCPCM Resource page contains tools, guides and templates for clinic teams and physicians, including recordings of our member-only Info Sessions.
Members of AMA's Clinic Managers Network have access to our PCPCM Financial Calculators. New members are welcome - apply today!
No. Joining the PCPCM is a decision to be made by the individual physician.
When a locum physician comes into a PCPCM practice, there are two options for establishing the billing and payment processes:
- Option 1: locum submits claims using the host physician’s PCPCM BA
- Option 2: locum submits claims using their FFS BA
In either scenario, the physician's PRAC ID will be used on claim submissions, indicating which physician provided the service. Learn more about locum coverage options.
Should payment flow through to the clinic's bank account, the Statement of Assessment can support fund distribution and administration. Each claim will list the individual physician's PRAC ID.
According to the Physician Resource Guide, claims should be submitted with the host physician's PCPCM BA in the Business Arrangement Field, and the locum BA field is left blank.
The locum's PRAC ID must be entered in the PRAC ID field to identify the service provider.
Yes. Two locums can support a host physician, but they cannot bill under the same PCPCM BA simultaneously. If one locum works at the clinic in the morning and the other works in the afternoon, they can use the host physician's PCPCM BA as long as their billing periods and services don't overlap.
There are no minimum practice hours for locums.
Video support tools, a discussion template and a guide for facilitating Practice Agreement discussions are available here. These support tools do not constitute legal or financial advice.
Recent graduates interested in joining PCPCM should contact the ACTT Support Team at [email protected] to be connected with a Primary and Preventative Health Services representative. A formal process is still under development.
The application process will differ slightly from the standard route. New-to-practice physicians will need to be live on CPAR, but aren't required to have 500 patients on their panel at the time of their application.
See Section 9.0 of the Operations Manual for more details.
All physicians must be live on CPAR before Primary and Preventative Health Services can issue a PCPCM BA.
Panel payments for PCPCM are determined by the number of patients attached to a family physician’s PCPCM panel (derived from CPAR). Learn more here.
Encounters led by a resident or medical student and the time spent supervising can be billed under the PCPCM as long as the PCPCM physician is in the patient's presence. The resident or medical student’s time cannot be claimed under PCPCM.
See Section 4.8 Clinical Services provided by Students, Residents and Trainees in the Operations Manual for more details and Alberta Health Bulletin 97 for general billing rules for supervised services with residents and medical students.