What is EOB 44, and what causes this rejection?

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. Manitoba Health’s registration database will automatically reject claims which do not include matching sociological data with an Explanation of Benefit (EOB) code ​“44”. The sociological data which must match Manitoba Health’s registration database is:

• six digit Manitoba Health Registration Number
• surname
• given name
• date of birth
• sex; Male [M], Female [F], Non-binary [X]
  

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

Retrieving updated sociological data:

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. To download a copy, click here.

The completed form may be faxed to Manitoba Health at (204) 783‑2171 or mailed to 1011 — 300 Carlton Street, Winnipeg, Manitoba, R3B 3M9. At that time, Manitoba Health staff will endeavour to complete/​correct the data included on the form and fax or mail the information to you. 

What appears to cause the most significant 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 may not have reported the change to Manitoba Health. Or, the reported change may not yet have been changed on record, possibly due to the patient not providing the appropriate legal documentation to accompany the change. 

In such scenarios, submit the claims using the information shown on the Manitoba health card presented by the patient. Ask the patient to contact Manitoba Health to report the change. 

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. Obtain these forms by calling (204) 786‑7101 or toll-free at 1−800−392−1207.

Guidelines to minimize rejected claims: 

1. When patients call for an appointment or when patients are sent written confirmation of an appointment, advise them they must present their Manitoba Health card when they attend their appointment.
2. If a patient presents 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
   1. Submit a form ​“529” to Manitoba Health to obtain the correct information before submitting the claim form.
   2. Submit the claim using the information you have available and, if the claim is rejected code ​“44”, either
      1. contact the patient to obtain information and resubmit the claim, or
      2. submit a form ​“529” to Manitoba Health and when you have received the correct information resubmit the claim;
   3. 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:
   1. 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, to expedite the addition of the newborn to their family registration number, they should 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 at 1−866−608−2983.
4. Where you must rely on a hospital’s information 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.