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TM1 - Duplicate Virtual Care Claim for Same Patient

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Background:

The “TM1” error code will be issued and the entire claim will be returned to the physician’s/dentist’s error report if:
a) a second virtual care claim is submitted by the same physician/dentist for the same patient on the same date of service; or
b) there is more than one Virtual Care Program B-code on the same claim; or
c) if the duplicate claim was submitted in error; or
d) if the duplicate claim was intentional because a second video visit was provided to the same patient on the same day for valid clinical reasons.

Solution:

a) The physician/dentist should confirm if the original or duplicate virtual care claim is for the wrong patient.
i. If the duplicate claim is for the wrong patient, then the claim should be resubmitted with the correct patient’s Health Number.
ii. If the duplicate claim was submitted in error, no further action is required.
iii. If the duplicate claim is intentional because a second video visit was provided to the same patient on the same day for valid clinical reasons, then the rejected virtual care claim should be resubmitted with the
Manual Review indicator checked and written explanation provided for adjudication purposes.
b) Resubmit the virtual care claim with only one Virtual Care Program B-code.

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

 

 

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