Bulletin 220301 — 2021–2022 Cumulative Preventive Care Bonus Information
Physicians in Patient Enrolment Models may begin to submit their 2021/2022 Preventive Care Bonus
To: Eligible Patient Enrolment Model (PEM) Physicians, Comprehensive Care Model (CCM), Family Health Group (FHG), Family Health Network (FHN), Family Health Organization (FHO), Blended Salary Model (BSM), Group Health Centre (GHC), St. Joseph’s Health Centre (SJHC), Weeneebayko Area Health Authority (WAHA), Rural and Northern Physician Group Agreement (RNPGA), GP Focus HIV (HIV)
Category: Primary Health Care Services
Written by: Negotiations Branch, OHIP, Pharmaceuticals and Devices Division
Date issued: March 28, 2022
Bulletin Number: 220301
The ministry provides all Patient Enrolment Models (PEMs) with the following information to assist with the calculation and submission of their Cumulative Preventive Care Bonuses:
- Information and Procedures for Claiming the Cumulative Preventive Care Bonus (Revised April 2020)
- A Preventive Care Target Population/Service Report (TPSR) for the 2021/2022 fiscal year
- A TPSR with projected patient information for the 2022/2023 fiscal year.
Please note that Family Health Group (FHG) and Comprehensive Care Model (CCM) physicians who did not meet the minimum roster size will receive a Target Population Service Report with projected patient information for the 2022/2023 fiscal year.
Beginning March 31, 2022, and consistent with the Information and Procedures for Claiming the Cumulative Preventive Care Bonus guidelines that are already in place, physicians are requested to claim for the preventive care service levels they have achieved for their enrolled patients during the period April 1, 2021, to March 31, 2022.
Where to find your Roster Size
The Roster Capitation Reconciliation Report included in the monthly reporting to FHG and CCM providers via Medical Claims Electronic Data Transfer includes a count of “previous month-total patients” and the “current month-total patients”.
Medical claims electronic data transfer
As outlined in INFOBulletin #11192 all providers will receive their Target Population/Service Report electronically via Medical Claims Electronic Data Transfer (MCEDT) to their Solo accounts. If you have not yet registered your solo billing number for MCEDT you will need to do so to receive this report.
Claims submission for eligible physicians
As regular stale-dating rules will apply, please ensure your bonus claims are submitted prior to the claims processing cut-off date in September 2022. Refer to the Information and Procedures for Claiming the Cumulative Preventive Care Bonus document, section 6.4 Submission Deadlines. Only claims for these five (5) bonus categories received on or prior to the cut-off date are guaranteed to be processed for payment.
Physicians who have changed billing software need to ensure they can submit Preventive Care Bonus claims without a health number, version code or date of birth. If your software does not allow for this submission, please contact your software vendor for an update.
Please note that eligible physicians should submit bonus claims using the normal billing practices used to submit Fee for Service claims. Details for submitting bonus claims are included in the enclosed Information and Procedures for Claiming the Cumulative Preventive Care Bonus document.
Cumulative Preventive Care Bonus, TPSR; Target Population/Service Report;
The Information and Procedures for Claiming the Cumulative Preventive Care Bonus document is posted on the Ministry of Health website.