Rejection Reasons and Common Fixes For MSP Billing : Cloud Practice

The following are some of the most common rejection reasons with some tips on how to resubmit your claims.

B: Patient's eligibility with MSP is in question. Please have patient contact MSP.

This can sometimes happen if the patient has moved or their coverage has expired, the patient will need to contact MSP directly at 1 800 663-7100.

AB: PHN is not on our records.

This can happen if you have keyed the incorrect PHN, you will need to confirm with your patient the correct number.

AF: This patient does not have coverage for the DOS.

This is also common for patients that have moved out of province and are not yet covered by MSP. If they are new or returning residents of BC they have a waiting period of 90 days before benefits can begin. The patient will need to provide you with their out-of-province health number (if applicable, excluding QC residents) or they will need to contact MSP to backdate their coverage date.

AQ: Surname does not match our records.

This can occur when a patient has changed their last name with your office but has not officially changed it with MSP. You can call the IVR system to check the last name on file, 1-800-742-6165 ext 4.

BV: Service date exceeds allowable claim submission period.

The MSP deadline to submit your claims is 90 days from the date of service. If your claim has this rejection, you can submit an ‘over-age claim request’, below is the direct link to the form. Once MSP gives you the okay to resubmit your claims, you will need to change your 'Submission Code' to “A- Post 90 day - Requested Pre-Approval”, this will be found under the advanced tab.

CF: Time called or time service was rendered is missing or invalid.

Some service codes, for example, Telehealth codes will require a start and end time. This time can be entered in ClinicAid under the ‘Extra Fields’.

FG: Age of patient does not correspond with the fee item billed.

MSP has some age-based codes i.e. 13537-TELEHEALTH GP VISIT: AGE 50-59 and 13637-TELEHEALTH GP VISIT: AGE 60-69. Keying errors may occur, to avoid this you can add these age-based codes (or associated codes) in your favourite codes list (link to solution).

IQ : Refractory period is 30 minutes for non-operative continuing care surcharges unless for CCFPP care.

When a physician is called out to attend more than one patient, the physician may bill non-operative continuing care surcharges, fee items 01205, 01206 and 01207. When billing these fee items ‘CCFPP’ (continuing care from previous patient) must be included in the claim note. Note *If you’re scheduled to be there then you aren’t eligible to bill these codes on routine visits or rounds.

XA: RCP claims - birthdate and sex code missing or invalid. And X9: RCP address missing or not showing in line one.

For all out-of-province claims, you must include the patient’s PHN, their full name, gender, dob and full address (including postal code). This information can be added to the patient’s chart or in the claim under the “patient” tab.

X2 : Facility number is missing or invalid.

If you have applied for the BCP (Business cost Premium), you will be given a unique facility number. If entered incorrectly you will receive this rejection. To avoid mistypes, go to your Provider Record under ‘Admin’ and enter it there.

W2: Data centre and payee number combination not on file.

A Teleplan Data Centre Number is just an identification number for MSP to manage your file uploads and downloads which is done through ClinicAid. You will need to apply for a Teleplan Data Centre Number where you can connect your Payee Number. If you have changed your Payee Number and have not submitted the form to Teleplan your claims will not be processed. If you have not connected your Payee Number to a Teleplan Data Centre, below are the links:

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