Keeping Health Care Providers informed of payment, policy or program changes

To: Providers
Published by: Claims Services Branch, Ministry of Health
Date Issued: June 16, 2020

The arthroscopic knee surgery Medical Claims Adjustment (MADJ) reported on the April 2020 Remittance Advice (RA) did not process all claims. A number of claims that had been previously paid at $0.00 were not adjusted. A subsequent MADJ is required and will report on the July 2020 RA. Included in this MADJ are arthroscopic knee surgery claims that were previously paid at $0.00 with service dates from October 1, 2019 - October 31, 2019.

Please also note during the MADJ process, the claims processing system selects an entire claim and reprocesses it. A single claim can include multiple fee schedule codes and all codes will be reprocessed. Claims that were reprocessed with no change in payment will appear on the Remittance Advice (RA) with explanatory code ‘55-This deduction is an adjustment on an earlier account’ and ‘57-This payment is an adjustment on an earlier account’. These two transactions will net out to zero with no payment impact but will report on the RA for reconciliation purposes.

For further details relating to Arthroscopic Knee Surgery, please refer to INFOBulletin #4737.

For any further inquiries, please contact the Service Support Contact Centre at 1-800-262-6524