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TM5 - Telemedicine claim already paid for this patient

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Background:

A claim will be rejected with TM5 if a non-telemedicine claim is submitted and a payment for a telemedicine billing was already made to the same physician for the same patient on the same date of service. This error condition will not apply if the non-telemedicine claim is for services that are excluded from the telemedicine program

 

Solution:

If the non-telemedicine claim was submitted for services omitted from telemedicine billing then the physician will have to request an adjustment be processed by the Ministry of Health by submitting an RA Inquiry. If the non-telemedicine claim and telemedicine billing are correct because the physician rendered both services on the same date in both telemedicine and non-telemedicine settings, then the rejected non- telemedicine billing should be resubmitted with Manual Review and a written explanation should be provided to the assigned Claims Assessor.

 

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