ARP billing, APP or Shadow Billing in Alberta all refer to the same process of billing to an Alternate Payment Plan where you are invoicing outside of regular Fee For Service billing. ARP's are usually a part of a group that pays them directly based on the time spent with patients.

Setting up for Sessional ARP Billing

You will first require a new ARP BA

To set up up an ARP provider in ClinicAid you would need to create a new provider under 'Admin' from the left side menu, and 'Providers', and toggle the 'ARP billing' flag at the bottom of the page to 'true', as well as add your new ARP BA number to the BA field.

ARP Billing in Alberta

 As all ARP billing comes back as accepted at zero dollars, normally these invoices would go to your Requires Action, with the ARP flag on, they will automatically settle for your convenience.

If you want to confirm that each invoice was actually accepted you can view your remittance under 'Reports' from the left side menu, and 'Remittance Report', then the 'View Results' link to the right. This will give you the raw data from the Remittance that we receive. In this view you can look at the A.Outcome column, if the response is A, that means the invoice was accepted and your ARP group will pay out based on the time you had input for that invoice.

Creating ARP Invoices

You will create your invoices as per usual under 'Create Invoices' from the left side menu, submitting your service codes, diagnostic codes and service dates per usual. Where ARP billing differs is that in the Fee Modifier fields you will record your time with the TM01-TM99 modifiers. Each TM modifier unit is 5 minutes, so in the below example the visit lasted 15 minutes (TM03).

Alberta Health requests that you still submit regular FFS modifiers such as CMXC30 for data purposes only, however, your payment is solely based on your time modifiers (TM) submitted.

ARP Billing in Alberta

As the TM modifiers are ubiquitous and can be used on all service codes we do not display them in the search/auto complete tables as we do with regular FFS modifiers, they simply need to be typed into the fee modifier field.

Finally, the dollar amount displayed is still the default FFS as provided by Alberta Health, as all ARP's have different contracts that pay out differently per time unit, we are unable to show the final amount you will receive for the work you have completed.