Enhanced Virtual Care Codes – Claims System Update

February 16, 2022

Alberta Health has announced the claims system is now ready to accept claims for HSCs 03.03CV, 03.03FV and 03.08CV with a complex modifier.

  • Do NOT add text to any claims unless instructed by Alberta Health, adding unnecessary text will force the claim into a manual review queue causing delays in payment.

Be sure to use action code “C”.

Physicians are strongly encouraged to submit their claims for dates of service January 1 – February 14, 2022, as soon as possible. Submitting these claims within the 90-day submission period will allow them to be automatically assessed and avoid delays in payment.

In the event that physicians are unable to submit their claims for HSCs 03.03CV, 03.03FV and 03.08CV with a complex modifier within the 90-day time period, for dates of service January 1 – February 14, 2022 only, a request for an extension can be made by writing to Sue Penner, Provider Relationship and Claims Team Lead, Alberta Health at Sue.Penner@gov.ab.ca. The request will be reviewed and a written reply will be provided. Approved requests will receive submission instructions, and all claims granted the extension must be submitted by May 15, 2022.

If you need to resubmit a claim

If you submitted claims for HSCs 03.03CV, 03.03FV and 03.08CV dates of service January 1 – February 15, 2022, without a complex modifier but the claims were eligible for a complex modifier, you may now resubmit the eligible claims with a modifier to receive payment for the modifier. To submit the claims with a modifier you must

  1. Retrieve the original claim in your billing software (assuming the claim paid as submitted without any explanatory codes on the Statement of Assessment from AH).
  2. Add the appropriate modifier to the claim.
  3. Resubmit the claim using action code “C”.

You should receive payment for the modifier portion of the claim only on the next Statement of Assessment from Alberta Health.

Reminders

  • Do not add text to any claims unless instructed by Alberta Health, adding unnecessary text will force the claim into a manual review queue causing delays in payment.
  • Be sure to use action code “C” as it signals that there is a change to the claim. The payment system will then process ONLY the changes. The next statement of assessment from AH will include a payment for the modifier portion of the claim only. If you are unclear about action code “C” be sure to use the original claim number and add the modifier and submit the claim. Your software should process only the change. If you have questions about your specific software, please contact your software provider.
  • Use the original valid claim number; do not generate a new claim number. If you use a new claim number or generate a new claim, AH’s payment system will deem the second claim to be a duplicate and the new claim will reject.

For more information about claims submission processes, please refer to section 3.0 Claims Submission of the Physicians Resource Guide.

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