Discussions between Doctors Manitoba and Manitoba Health have clarified how claims are to be submitted and paid for tariff 5622, Planned anterior vitrectomy as a secondary procedure.
Arising from these discussions, two amendments were made to the tariff. Firstly, the following note was added to the tariff:
“Tariff 5622 is payable only when prior approval has been obtained or supporting documentation showing the planned nature of the procedure is submitted with the claim. Examples of the types of supporting documentation which, alone or in combination, may be submitted to substantiate the planned nature of the procedure are: operative report; hospital booking request form; hospital ophthalmology history sheet; patient consent form.”
Secondly, wording was added to the tariff that specifies that the tariff is payable as an “add-on”.
As a result of these tariff changes, ophthalmologists claiming tariff 5622 should be aware that:
|1.||Claims should be paid at 100% and not reduced to 75% of the listed fee.|
|2.||Manitoba Health will process claims under tariff 5622 if:|
|a.||the claim is pre-approved, or|
|b.||if the claim is not pre-approved, the claim is accompanied by evidence that demonstrates
the procedure was”planned”.
|3.||Unplanned anterior vitrectomies completed in association with complicated cataract surgery (or other surgeries such as corneal transplants and intraocular lens replacement) will not be paid.|
Updated: December 2016