Billing for Multiple Insurers
If a patient is seeing a physician and a number of different insurers have payment responsibilities to that patient, total claims should not exceed the amount that would apply if a single insurer were responsible.
When a patient is treated for multiple conditions during one visit, and each condition is the responsibility of a different insurer, only one visit can be billed. When treating patients for conditions that are the responsibility of an insurer other than MSP, such as WCB or ICBC, the appropriate insurer must be identified on the billing sent to MSP.
The insurer to be billed is the one that is responsible for the primary reason for the visit or the one responsible for the condition that took the greatest portion of the time of the visit.
Note: Only one insurer can be billed for a single visit.
The patient presents with:
Sore shoulder resulting from a work-related injury (WCB)
Bruised knee resulting from a motor vehicle accident (ICBC)
Assuming that the largest portion of the visit is spent treating or evaluating the shoulder injury, WCB can be billed the applicable visit fee (example, fee item 00100) at 100%. Claims cannot be billed to ICBC for the bruised knee or to MSP for the bronchitis.
|Tips:||Claims are always billed at the MSP amount. Where applicable, ICBC or WCB adjustments will be made and will appear on the remittance statement.|
|MSC Payment Schedule rules for multiple services apply when multiple insurers are involved.|
|For information regarding visits and minor procedures where services are the responsibility of multiple insurers, please refer to Preamble B.12.|