The Ministry has provided new documentation regarding ‘good faith claims’.
Please follow their guidelines below to obtain payment. There is no 'good faith' indicator, and you will have to email Alberta Health at pboffice@ahs.ca with the details of the encounter to obtain payment as per Alberta Health's instructions below.
Alberta Health uninsured services documentation:
“As per the recently ratified Alberta Health/AMA agreement, Alberta Health commits that physicians will be paid for the provision of insured services to Alberta residents who are eligible for coverage under the Alberta Health Care Insurance Plan (AHCIP) at the time of service but cannot provide proof of AHCIP coverage. In this regard, I can provide you with the following information.
A practitioner or their staff are responsible to verify that a patient has active coverage under the Alberta Health Care Insurance Plan (AHCIP). It is important that practitioners and their staff, after questioning the patient, are confident that:
1. The patient is a permanent Alberta resident and eligible for AHCIP coverage, and
2. The patient is who they say they are. Patients must present two pieces of original identification, including at least one that includes a photo and at least one that displays their current Alberta address.
Health practitioners and facilities have access to a variety of convenient tools and options to confirm a patient's eligibility for AHCIP coverage.
• Alberta Health provides a 24-hour interactive telephone inquiry service at 1-888-422-6257 that enables physicians and their staff to check if a patient’s Personal Health Number (PHN) is active.
• Physicians and office staff can also verify if a patient’s AHCIP coverage is active using Alberta Netcare.
• All patient information is available to physicians in hospital ADT/CIS systems (Connect Care, Meditech, etc.) to assist them with completing their claims.
• Physicians are also able to connect directly with the hospital registration area and/or health records department of the hospital, which will provide patient registration information.
Hospital registration staff follow the Provincial Registration Standards and Practices that were developed jointly by Alberta Health and Alberta Health Services (AHS). Hospital registration staff are responsible to ensure that all demographic and coverage information is collected and up to date when patients come into an AHS facility for insured medical services.
• If patients are unidentified at the time of registration, the care team will notify registration as soon as the patient is able to communicate, or they will direct the family to registration to provide updated information.
• If a record of the individual cannot be found on the hospital registration system or Netcare, unit staff will either request the assistance of the AHS ID Program or the hospital social worker to assist the individual with registering with the AHCIP for coverage.
• The AHS ID program works with the Alberta Health Insurance Programs Registrations Unit to ensure criteria are met before patients are enrolled in AHCIP.
• AHS staff will notify the physician when the PHN has been accurately inputted into the hospital registration system, so the physician is able to use this information to submit claims for insured services to Alberta Health for payment for services provided.
In situations where a physician has provided health services for a patient and hospital registration staff cannot confirm the patient’s coverage eligibility via the above mechanisms; physicians must contact the AHS Provincial Professional Billing Office for assistance with facilitating the billing process. Using their AHS email address, a physician can send an email to pboffice@ahs.ca with the details of the encounter (date, location, summary of services provided and whatever identity information has been provided).
When a practitioner can reasonably demonstrate that all options to obtain the PHN of the patient were attempted without success, Alberta Health will ensure payment to the practitioner for services provided no earlier than April 1, 2022, to Alberta residents who are eligible for coverage under the AHCIP but were unable to provide proof of AHCIP coverage at the time of service.
Physicians can email Alberta Health at health-pcsp.admin@gov.ab.ca and provide the following:
1. date of service;
2. location of service;
3. summary of services provided;
4. whatever identity information is available, and;
5. details to demonstrate efforts to obtain the PHN
Alberta Health will follow up on any circumstance where a physician has experienced challenges securing a PHN for the purposes of billing for payment of insured services performed in AHS facilities or where the registration process has not been facilitated in a timely manner as described above.
Once it is determined that a physician exhausted all reasonable efforts to obtain the PHN of the patient and the PHN remains unavailable, Alberta Health will provide the physician with instructions on how to submit a claim for payment of services. “
Please Note: If your patient is a Refuge, Canadian Armed Forces, or RCMP you can submit claims directly for payment to Medavie Blue Cross: https://www.medaviebc.ca/en/health-professionals