Submission of Claims – Six-Month Deadline

Physicians and their billing staff should be aware that the deadline for submission of claims to Manitoba Health is six months from the date of service.

The Manitoba Health Physician’s Manual states, “Where a claim(s) is not submitted to the Claims Section within six (6) months from the date on which the service was rendered, the claim(s) will not be payable. This requirement may be waived under exceptional circumstances. An explanatory letter outlining the circumstances should be submitted with the claim(s).”

Manitoba Health has advised that late claims are reviewed on a case-by-case basis. The following are examples of situations that may result in the time frame being extended: disasters (fire/flood), fraud, theft of computer or patient files, major computer problems and claims refused by Workers’ Compensation Board.

Extensions beyond six-months are generally not granted for lost/misplaced claims or situations involving low volume or low dollar amount of claims.

Requests for claims submission beyond the six-month time frame should be sent by letter to Ms. Cynthia Bayluk, Assistant Manager, Claims Unit, Insured Benefits Branch. Your letter should outline the extenuating circumstances and include a contact phone number where you can be reached.

Claims rejected due to the six-month timeframe cannot be charged to the patient. A physician’s only recourse is to write-off the value of the claim as a bad debt.

Most provinces allow up to six months from the date of service to claim submission. However, the time limit is three months in Nova Scotia and Quebec.

Questions?

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

 

Updated: December 2016