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TM3 - Service not payable under telemedicine program

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Background:

You may see this rejection when both Telemedicine and non-Telemedicine codes were submitted within the same claim and one or more of the OHIP codes has been ‘identified as being excluded from the telemedicine program’.

Please refer to page 3 of the OTN OHIP Telemedicine Billing Information manual for the full list of OHIP codes that cannot be billed within a Telemedicine claim.

https://support.otn.ca/sites/default/files/ohip_telemedicine_billing_information_manual.pdf

Solution:

If you have intended to bill both OHIP and Telemedicine codes, the claim can be resubmitted:

If you are billing a code from the excluded service list, the claim can be resubmitted as is with Manual Review.  You will need to fax an explanation letter to your claim assessor who may approve the code combination.

If you are billing a telemedicine excluded service that was rendered to the patient via a face-to-face encounter outside of the telemedicine session, the claim can be split, and the non-Telemedicine services can be billed separately without the telemedicine premium and without the SLI (Service Location Indicator).

 

 

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