Explanation of Benefit (EOB) 44 – Practical Guidelines

It is the practice of Manitoba Health and other public health insurance plans across Canada to reject claims that do not include complete sociological data that matches the health plan’s registration database.

Claims which do not include sociological data that matches Manitoba Health’s registration database will be automatically rejected with an explanation of benefit (EOB) code “44”. The sociological data which must match Manitoba Health’s registration database is:

  • 6 digit Manitoba Health Registration Number
  • surname
  • given name
  • date of birth
  • sex

Claims that are rejected for incorrect sociological data should be corrected and resubmitted, and NOT queried.

Manitoba Health will assist physicians in obtaining accurate sociological data on their patients. If you require information on patient eligibility, complete a “529” form Request for Manitoba Health Registration Number. A supply of these forms may be obtained by contacting Manitoba Health at (204) 788-2589.

The completed form may be faxed to Manitoba Health at (204) 942-2356 or mailed to 300 Carlton Street, Winnipeg, Manitoba R3B 3M9. Manitoba Health staff will endeavor to complete/correct the data that has been included on the form, and will thereafter fax or mail the information to you.

What appears to cause the greatest confusion is when a patient reports to a physician that the information contained on their Manitoba Health card (e.g., surname) has changed. The patient has either not reported the change to Manitoba Health, or, if the change has been reported, Manitoba Health’s records have not yet been changed, possibly because the patient has not yet provided the appropriate legal documentation to accompany the report of change.

In such scenarios, claims should be submitted USING THE INFORMATION SHOWN ON THE MANITOBA HEALTH CARD PRESENTED BY THE PATIENT. It is recommended that you ask the patient to contact Manitoba Health to report the change. You may wish to keep on hand a supply of Please Reply Promptly Cards – form “66” to provide to patients who need to report such a change to Manitoba Health. These forms may be obtained by calling (204) 786-7101 or toll free 1-800-392-1207.

Below are some practical guidelines to assist physicians and billing staff to minimize rejected claims. Please review these guidelines carefully and keep handy for reference.

  1. Advise all patients when they call for an appointment and/or when a written confirmation of appointment is sent out to them that they must present their Manitoba Health card at the time they attend for their appointment.
  2. If a patient attends for an appointment and does not have their Manitoba Health card with them, aside from declining to provide the service, you have the following option
    i. Submit a form “529” to Manitoba health to obtain the correct information before you submit the claim form.
    ii. Submit the claim using the information you have available and, if the claim is rejected code “44”, either
    a) contact the patient to obtain correct information and resubmit the claim, or
    b) submit a form “529” to Manitoba Health and when you receive the orrect information resubmit the claim;
    iii In situations where you are uncertain whether the patient has Manitoba Health coverage, bill the patient directly and advise them that if they subsequently produce a valid Manitoba Health card, you will submit a claim to Manitoba Health and reimburse them.
  3. In respect to claims for services rendered to newborns:
    i. The parent(s) of a newborn must obtain a PHIN from Manitoba Health for the newborn.

    (Note:  You may wish to suggest to the parents of a newborn, that in order to expedite the addition of the newborn to their family registration number, they provide Manitoba Health a copy of the Registration of Live Birth they receive from the hospital.  This document may be mailed or hand delivered to Manitoba Health at 300 Carlton St. Winnipeg MB  R3B 3M9 or faxed to Manitoba Health at (204) 783-2171 or toll free 1-866-608-2983.)

  4. Where you must rely on information provided by a hospital in order to submit a claim, it may not always be possible to verify if the information provided matches the information on Manitoba Health’s database.In such cases, you can follow the recommendations in #2 above.
Questions?

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

 

Updated: November 2016