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Billing with No PHIN

Manitoba’s physicians are now able to invoice Regional Health Authorities for services provided to certain patients who do not have a valid Manitoba Health Card. This includes newborns, new residents, and some other groups.

Eligibility

Good Faith Billing allows physicians to submit fee-for-service claims for services provided to patients in hospital who are who are eligible for provincial health coverage but don’t yet have a PHIN. 

Physicians should confirm the patient meets eligibility for provincial health insurance, as outlined here by Manitoba Health. Some common examples of patients that are often eligible but don’t yet have a PHIN include those who are: 

  • A newborn without a PHIN 
  • A new resident of Canada 
  • Experiencing temporary homelessness 
  • Post-incarceration

To be eligible for Good Faith Billing, services must be provided in hospital settings, including inpatient care settings. 

What’s Not Covered

Good Faith Billing is also not intended to cover patients that aren’t eligible for Manitoba Health coverage. Some common examples of patients who are not eligible include: 

  • Tourists in Canada from other countries 
  • Patients from Quebec 
  • Transients
  • Most out-of-province students 

Medical services provided to these populations should be billed to the patient directly in accordance with the Doctors Manitoba Uninsured Services Resource Centre, found here.

Good Faith Billing only covers hospital services for patients that meet the eligibility. Services provided outside of emergency rooms and hospitals, such as in primary care offices, are not eligible to be invoiced under the Good Faith Billing protocol. In this scenario, patients should be instructed to visit Manitoba Health to get their Health Care and PHIN to provide coverage for medical services. 

Submitting Good Faith Claims

If a patient meets the eligibility for Good Faith Billing (i.e. eligible for Manitoba Health coverage and care is in a hospital), you should proceed with submitting an invoice for the services you provided. You should claim using fee-for-service tariffs outlined in the Physicians’ Manual, at current rates. 

Physicians or their staff should prepare an invoice for all services rendered, and must include the following information. 

  • The MRN of the patient 
  • The date of the visit/​procedures
  • Facility of the visit/​procedures
  • Tariff code(s) from the Manitoba Physician’s Manual for all service(s) delivered 
  • Amount per transaction (tariff code amount) 
  • Total amount being submitted 

Invoices should be submitted to the appropriate Regional Health Authority using the following contact information: 

Invoices must be submitted within 180 days of the date of service. They should be processed within 60 days of receipt.

We remind physicians to include, where applicable, special calls, after-hours premiums and other add-ons that might be applicable under the Physician Services Agreement. 

Please note that this Good Faith Billing process applies to all physician services including anesthesia services and surgical assistance. 

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