You can bill an out of province (OOP) or reciprocal claims through ClinicAid. 

Residents of all the Canadian provinces and territories (except Quebec) are covered under the Interprovincial Reciprocal Payment Agreement for Physician Services.

This document covers how to bill an Out Of Province claim and how to fix a rejected Out Of Province claim.

How to bill an Out Of Province claim:

Set up your patient as out of province.

 

  1. Click on “Create Invoice” in the left-hand menu of ClinicAid.

  2. Click on the “+” sign in the “Patient Information” box on the right to create a new patient.



  3. Select “Default OOP” from the top right drop down in the “Add a new patient” pop up.



  4. To successfully submit a claim for an out-of-province patient, you must include the following information:

·         First Name and Last Name

·         Health Card Number (out of province)

·         Healthcare Type (the province patient is from)

·         Date of Birth

·         Gender

·         Full address including postal code

 

 

    

       5.    Click the blue “Create Patient” button on the bottom right and bill as usual. 

If you create your patient like this from scratch ClinicAid will automatically configure your invoice as a reciprocal claim.

How to fix a rejected Out Of Province claim:

If you're dealing with a rejected invoice that was incorrectly formatted you will have to do this process manually:

 

To Change on Patient’s Chart and Invoice: 

  • Update the patient's details under your 'Manage Patients' menu. 

  • Add the patient’s “Gender”. 

  • In the ‘Health and Service Information’ section add “Healthcare Type” (province patient is from) and “Health Number” (out of province health card #) in the box below it.

  • Also, add the full address including postal code. Then click the blue “Update Patient” button to save.


 



  • Once this is done, go back to the ‘Manage Invoice’ section, edit the invoice in question and hit the 'reload' button next to the patient's name (see screenshot). This will add all of the updated patient details into your invoice automatically.

 

To Change on Invoice only:

  • The first step will be under the 'Advanced' tab to set the “Insurer Type” to ‘Out Of Province’.

  • Next, under the 'Patient’ tab enter the patients out of province health card number in the “Registration Number” box at the top.

  • Lastly, on the ‘Patient’ tab fill in the patients “Province” (province they are from), “Gender”, and full address including postal code.

    Note: If the claim is over 90 days it can be resubmitted with Submission Code C: "C - Post 90 day - Coverage Issue (Note required) (C)". Set the ‘Submission Code’ to “C” on the ‘Advanced’ tab.

Additional Resources:

 

How to get Out Of Province Health Numbers

 

Out Of Province Health Card Number Formats for Provinces and Territories 

 

British Columbia Health Ministry - out of province billing