Bulletin 201201 — Mailing and fee changes for K065 and K066 fee schedule codes
This bulletin provides updated information to INFOBulletin 4636 for Periodic Oculo-Visual Assessments for Social Assistance Recipients effective April 1, 2020.
To: Physicians, Hospitals, Clinics and Laboratories
Category: Physician Services, Optometry Services
Written by: Health Services Branch, Ministry of Health
Date issued: December 10, 2020
Bulletin Number: 201201
Social Assistance Recipients with a valid Health Card
Claims for Periodic Oculo-Visual Assessments (POVAs) provided to social assistance SA recipients who have a valid health card are to be submitted to OHIP in the usual manner using the appropriate fee code:
- K065-Ontario Disability Support Program (includes Family Benefits Program) $50.65
- K066-Ontario Works $50.65
Please note that there have not been any changes to the above process.
SA Recipients who do not have a valid Health Card or the claim has rejected with an ‘EPS-Patient not eligible for program’ error code.
In order for payments to be processed for POVA services provided to patients who do not have a valid health card or where the claim has rejected from the claims system with the error code EPS, the provider must submit the following patient information to the Ministry of Health (ministry) to verify that the patient is a SA recipient.
Please provide all required information listed below for SA patient related claims:
- First and Last Name of Patient
- Patient’s Address
- Date of Birth
- Date of Service
- Provider Billing Number
- Provider Contact Information
In addition to the above information, any one of the following is also required:
- Copy of the Ontario Drug Benefit Card showing month of coverage
- Copy of the Statement of Social Assistance showing date of coverage
- Proof of Eligibility Letter from Ministry of Children, Community and Social Services (MCCSS) Social Assistance Office
- Eligibility confirmation report from SAV Portal (more details provided below)
- Confirmation # from MCCSS SAV Helpline (more details provided below)
The above information can be faxed or mailed using the contact information shown below.
Claims will be processed manually, and payments will appear on the monthly Remittance Advice (RA) once the identified information has been received by the ministry.
Note: There has been a change to the MOH mailing address.
Contract Management Unit
Health Services Branch
Ministry of Health
49 Place d’Armes, 5th Floor
PO Box 48
Kingston ON K7L 5J3
Note: There is no change to the way that eligibility for POVAs is determined. Each person is eligible for one assessment per 24-month period.
In July 2018, Ministry of Children, Community and Social Services (MCCSS) introduced a new Social Assistance Verification (SAV) Portal for providers to verify a patient’s eligibility for the Ontario Disability Support Program (ODSP) including Assistance for Children with Severe Disabilities (ACSD) and Ontario Works including Temporary Care Assistance (TCA) and M’Chigeeng First Nation only.
To access the SAV Portal to verify a patient’s eligibility, you will need a unique SAV PIN that will allow you to register for an account. The SAV PIN is not the same as your IVR PIN. If you have not received a SAV PIN from MOH, please complete the Social Assistance Verification Portal PIN Request Form. Beginning August 2019, the form is also available for download through the SAV Portal Home Page. Submit the completed form to for processing.
Once you have received your SAV PIN, please navigate to the hyperlink to Register for a SAV Portal account.
Contacting the Social Assistance Verification (SAV) Helpline will remain available to providers in a diminished capacity. If you cannot access the SAV Portal or if a client does not provide alternate proof of eligibility, physicians can call the MCCSS SAV Helpline to confirm eligibility at 1-888-284-3928.
K065; K066; Periodic Oculo-Visual Assessments; Social Assistance; Ontario Works, Ontario Disability Support Program; POVA; SAV; EPS.
Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.