How do I bill E405/E404/E415 retroactively for the procedures that have been submitted/paid?
MOHLTC has recently changed the retroactive submission process for the COVID-19 temporary premium codes:
- E404A - COVID-19 Temporary Modifier Payment for AGMPs (Outside of Hospital)
- E405A - COVID-19 Temporary Modifier Payment for AGMPs (Hospital)
- E415A - COVID-19 Temporary Premium for Life Threatening Critical Care
In the past, the process was to clone the claim and submit the premium and the procedure together. However, that is no longer allowed and the claim will be rejected.
To bill these premiums for procedures that have been paid in the past, MOHLTC is asking to create a new claim and submit the premium by itself (without the procedure).
ACTION (web only):
- New Claim
- Select a patient and enter the service code E404A/ E405A/ E415A
- Enter the service date and click Add Entry
- Action -> Edit to update the service fee. You will need to manually calculate & enter 30% of the procedures billed.
- Click Update and Save
- These premiums can only be submitted alone (retroactive billing) on the web portal. You can not submit these premiums alone on the mobile app. For new procedures, you can continue to submit these premiums for procedures that have not been submitted in the past using both web and mobile app.
- You can export your claims to an excel spreadsheet (Reports & Forms --> Advanced Reports --> Export Claims), and search for the AGMP eligible procedures. You can then create a separate column to calculate the 30% of the submitted value.
- E404A/E405A should only be billed for patients who are COVID-19 positive or who are treated as at risk of being COVID-19 positive under local hospital policy.
- E404A/E405A are daytime premiums for services that commence between 7:00 a.m. and 5:00 p.m. on weekdays (not to be used for services on weekends or holidays).
- E415A will not be eligible if physicians' hospital has chosen the option of reactivating their Protected Code Blue or Pre-Emptive Protected Code Blue response team funding. Hospitals can only utilize one of the funding approaches for Protected Code Blue or Pre-Emptive Protected Code Blue response teams.
If you have any questions, please email firstname.lastname@example.org.