To: Publicly Funded Community-Based Physiotherapy Clinics

Published by: Health Services Branch

Date Issued: May 17, 2017 Bulletin #: 3136

Re: Updated - Guidelines for Physiotherapy Service Encounter

Submissions
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This INFOBulletin replaces INFOBulletin 3112 – Guidelines for Physiotherapy Service

Encounter Submissions, dated February 3, 2015.

The following is being provided for information and reference purposes.

Before submitting service encounter codes to the ministry you must ensure your Medical
Claims – Electronic Data Transmission (MC EDT) registration has been completed. If you
have not completed your registration please refer to the detailed step by step guide in the MC
EDT Reference Manual and Procedure Summaries at the following link:
http://www.health.gov.on.ca/en/pro/publications/ohip/mcedt_mn.aspx

Note: As of December 31, 2014 MC EDT registration is mandatory.

Some of the Reports available to you from the ministry are listed below. Files will be available
to download for up to twelve (12) months from the date of creation. Files can be downloaded
multiple times during this period. For more details on how to access and download these
reports, please refer to the MC EDT Reference Manual at the following link:
http://www.health.gov.on.ca/en/pro/publications/ohip/docs/mc_edt_reference_manual.pdf

Please note that a Service Encounter submission has the same meaning as a claims
submission and that service encounters may be referenced as claims in manuals or reports
generated by the MC EDT system. An episode of care (EOC) includes multiple Service
Encounter submissions.

Posted Electronically Only

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File Reject Report

• This report is usually available for download within a few hours of the service encounter
file submission.
• This report notifies you that the ministry has rejected an entire service encounter
submission file. This means the file has been transferred correctly but the file does not
meet current ministry technical specifications.
• No service encounter codes included in this submission will be processed by the
ministry and the file must be corrected and resubmitted.

Batch Edit Report

• This report is usually available for download within 24 hours of the service encounter file
submission.
• If service encounters are uploaded on a weekend, holiday or at month-end, the Batch
Edit Report will be available on the next service encounter processing day.
• This is your receipt that the ministry received your file; however, it does not guarantee
approval of the submitted service encounters.

Error Repor t

• This report is usually available for download within 48 hours of a service encounter file
submission. If service encounters are uploaded on a weekend, holiday or at month-
end, the Error Report is delivered at the end of the next service encounter processing
day.
• This report provides a list of rejected service encounters and the appropriate error
code(s) for each service encounter.
• Error code descriptions and the reason for the reject can be found in section 6.4 of the
Technical Specifications Manual at the following address:
http://www.health.gov.on.ca/en/pro/publications/ohip/docs/techspec_interface_hcsm.pdf
• Rejected service encounters reported on your error report must be corrected and
resubmitted to the ministry within three months of the date of service. Refer to the
Reporting Requirements Guide for more information regarding service encounter
submissions.

Remittance Advic e (R A) Repor t

• The remittance advice is a monthly statement of approved service encounters.

• It is usually available for download within the first week of the month.
• Approved service encounters listed on the RA should be verified against your service
encounter file submissions.
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• If service encounters were submitted but do not appear on your remittance advice you
should review your error reports for rejected service encounters or batch edit reports for
rejected files.
• Rejected service encounters or files should be corrected and resubmitted within three
(3) months of the date of service.

Cut-Off Date for MC EDT Ser vice Encounter Submissions

The ministry operates on a monthly processing cycle. Submissions received by the 18th of the
month will typically be processed for approval the following month. When the 18th falls on a
weekend or holiday, the deadline will be extended to the next business day. MC EDT
submissions received after the 18th may not be approved until the next monthly processing
cycle. (i.e. submissions received on Nov 18th will appear on the December RA, submissions
received after Nov 18th may not appear until the January RA).

Ser vice Encounte r Submissions

All service encounters rendered for each patient must be submitted to the ministry using the
appropriate fee schedule code for reporting purposes (i.e. each time a patient is seen in your
clinic this must be reported). Service encounter reporting is not limited to discharges (V842A
or V850A). Please refer to Schedule E amended April 1, 2017, of your agreement or the
Reporting Requirements Guide for a complete listing of Service Encounter Codes and
Physiotherapy Diagnostic Codes to be used for service encounter submissions.

Reconciliation

Reconciliation of service encounters is the clinic’s responsibility. It is recommended that all

reports provided by the ministry be reviewed on a regular basis. This will ensure that any
discrepancy in the number of service encounters submitted vs the number of service
encounters approved by the ministry can be resubmitted in a timely manner. Service
Encounters must be submitted within three months of the date of service. A review of each
clinic’s service encounter submissions will be conducted yearly using the information provided
in the D4 Settlement Report.

Year-end reconciliations will be based on service encounter submissions received and

approved on the ministry’s MC EDT system.

Contacts

Inquiries related to MC EDT submissions are to be directed to the Service Support Contact
Centre at 1-800-262-6524. The desk is staffed from 8:00 am until 5:00 pm, Monday to Friday,
and your inquiry will be escalated to appropriate ministry staff. After business hours an
answering service is available and your call will be returned the following business day.

Contact your software vendor for questions or issues related to your billing software.