Training or Experience Required to Claim Certain Tariffs
Certain tariffs in the Physician’s Manual may only be claimed by physicians with specific credentials, training or experience. For many tariffs (e.g., visit page tariffs), the physician’s Manitoba Health designated bloc of practice is sufficient.
A physician’s Manitoba Health designated bloc of practice is determined by their College of Physicians and Surgeons of Manitoba (CPSM) designated specialty. (Specialty Restricted Fee Codes – Eligibility) Certain other tariffs specifically indicate additional training or experience are required. Generally, claims for these services will not be paid until confirmation of the additional training/experience has been acknowledged by Manitoba Health.
A Shared Health or RHA CMO or designate usually determines a physician’s training/experience. Doctors Manitoba and Manitoba Health must agree in some cases which physicians are approved to claim a tariff. (Doctors Manitoba has designated physician experts to provide it with recommendations in this regard.), Additionally, certain tariffs, such as shortlist laboratory tests require the approval of CPSM through its Manitoba Quality Assurance Program (MANQAP).
Note: It is usually quite tough to obtain payment from Manitoba Health on a retroactive basis (i.e., if confirmation of training/experience is not obtained before a service is provided). Therefore, obtain confirmation of the acceptability of your training/experience, and submit this information to Manitoba Health before providing the service. Especially if you intend to introduce a new service into your practice.
Contact Doctors Manitoba for further advice or assistance with the approval process.