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TM3 - Service Not Payable Under Virtual Care Program

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Background:

The “TM3” error code will be issued and the entire claim will be rejected and returned on the physician’s error report if a virtual care claim includes services that are not payable as a video visit by the Virtual Care
Program.

Solution:

If the fee service code included with the virtual care claim is incorrect, then the claim can be resubmitted with the correct fee service code.

If the fee service code is correct but is a service excluded from the Virtual Care Program (See the Virtual Care Billing Information Manual for Physician Service Excluded Codes), the physician should resubmit the claim with the Manual Review indicator checked and provide written explanation for adjudication purposes.

If the excluded service was rendered to the patient per a face-to-face encounter outside of the video visit, the physician can claim the service in a separate claim without a Virtual Care Program B-code and without the OTN SLI code for payment by OHIP.

For the instruction on how to flag Manual Review, see OHIP Billing Tip #11 - Manual Review

 

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