How to Handle Over-Age Claims
When the claim is over 90 days old, you can still submit the claim as usual for the following reasons:
- The patient’s coverage has been reinstated (use Submission Code = C)
- The claim has been processed by MSP but you disagree with the adjudication of the claim (use Submission Code = X)
- The claim has either been refused or accepted by ICBC since it was originally submitted (use Submission Code = I)
- The claim has either been refused or accepted by WorkSafe BC (WSBC) since it was originally submitted (use Submission Code = W)
If the claim becomes over-aged due to a reason not outlined above, you must submit a written request with a detailed explanation for an over-aged submission. The request must also include the date range of the claims, number of claims, the value of claims, and the fee items involved.
(Note: Administrative issues such as staffing problems, clerical errors, lost or forgotten claims, system or service bureau problems do not qualify for an exemption.)
When a written application is approved for retroactive billing, the maximum retroactive period will be six months from the date of approval. Only in very exceptional circumstances will claims be approved beyond six months. In those exceptional circumstances due to system restrictions, the maximum retroactive period granted will be 18 months.
MSP will respond (by fax) in writing to advise if the claims will be denied or approved. If the request is denied, the letter will advise of the next steps (i.e. the appeal process). If the request is approved, you can then submit the over-age claim as usual except that you will need to click Advanced Fields on the claim page and select the Submission Code A (Post 90 day - Pre-approval Claims).
Steps to submit an over-age claim requiring a detailed explanation:
- Create a claim and enter the claim information as usual
- Under Advanced Fields, select Submission Code = A (Post 90 Days – Pre-approval)
- Click Add Service and Save or Save and Submit
- Click OK on the pop-up window in order to be directed to create an over-aged claim pre-approval form.
- On the form page, select the over-age service(s) and fill out the explanation, then click Create Form. A PDF form will be downloaded to your local drive.
- Fax the form to the MSP at 250-405-3593 (Practitioner and Patient Services Claims Support).
Please note the over-age claim approval applies only to the exemption to the 90-day submission limit and does not guarantee payment. All claims billed are subject to the usual processing and adjudication rules and regulations.
For more information you can contact the Practitioner and Patient Claims Support via phone: 1-866-456-6950 or by fax: 250-405-3593.