Claims Disputes – The Role of Doctors Manitoba

Manitoba Health uses internal payment policies to guide its staff in administering claims. Many of these policies are intended to assist their staff in the processing of claims without having to request additional information from physicians. This streamlines the payment process.

However, the Physician’s Manual is a contract between Doctors Manitoba and Manitoba Health, and, like any other contract, is subject to differences of interpretation. Furthermore, the Physician’s Manual is not a static document. The parties have negotiated hundreds of changes, which have, on occasion, given rise to inadvertent uncertainty.

Given these factors, Manitoba Health’s internal payment policies may not always reflect how a particular tariff or rule is to be interpreted and applied. Consequently, payment disputes will arise from time to time that may not be able to be resolved through direct interaction between Manitoba Health and a physician and/or their billing staff.

When these disputes arise, physicians and/or their billing staff should contact Doctors Manitoba for advice and assistance. In these instances, we represent physicians as follows:

  • Providing advice to physicians and their staff regarding specific billing matters;
  • Representing physicians in discussions with Manitoba Health regarding payment;
  • Negotiating changes to the Physician’s Manual to clarify payment of claims;
  • Applying for the introduction of New Fee Tariffs;
  • Attending at meetings to discuss unresolved issues involving claims;

Questions?

Allison Crolly
acrolly@docsmb.org
(204) 985-5856

Roger Jamieson
rjamieson@docsmb.org
(204) 985-5849

 

Updated: November 2016