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TM4 -Non-Virtual Care Claim Already Paid for This Patient

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Background:

The “TM4” error code will be issued and the entire claim will be rejected and returned on the physician’s/dentist’s error report if a virtual care claim is submitted and a payment for a non-virtual care claim for a service eligible for payment by the Virtual Care Program was already made to the same physician for the same patient on the same date of service.

Solution:

If the previous non-virtual care claim (i.e. OHIP claim) was incorrect and should have been a virtual care claim, the physician/dentist will need to request an adjustment be processed by OHIP through existing claims adjustment procedures. If the non-virtual care claim and virtual care claim are correct because the  physician in fact rendered both services on the same day in both virtual care and non-virtual care settings, then the rejected virtual care claim should be resubmitted with the Manual Review indicator checked and written explanation provided for adjudication purposes.

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

 

 

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