Bulletin 221204 — Virtual Care Funding Framework Updates
Addition of new Fee Schedule Codes, Error Codes, and Explanatory Codes for the Virtual Care funding framework and changes for the 'OTN' SLI.
To: OHIP Billing Software Vendors
Category: Billing Software Specifications
Written by: Claims Services Branch; Health Programs and Delivery Division
Date issued: December 22, 2022
The Ministry of Health and the Ontario Medical Association have been working together to implement the new Virtual Care funding framework effective December 1, 2022.
Please ensure that your billing software is updated to include the new Fee Schedule Codes related to Virtual Care services rendered on or after December 1, 2022.
The updated Fee Schedule Master can be found on the Ministry of Health website.
The ‘OTN’ Service Location Indicator will be discontinued for claims with service dates on or after December 1, 2022.
New Error Codes
The following new error codes will be applied to claims with service dates on or after December 1, 2022:
|AT1||Only One Modality Allowed|
|AT2||Must Include Vid Modality|
|AT3||No Pat-Phys Relationship|
|AT4||Modality Not Allowed|
|V73||OTN SLI No Longer Active|
For a complete listing of Error codes please see Error Report Rejection Conditions/Error Codes.
New Explanatory Codes
The following new explanatory codes will be introduced effective December 1, 2022:
|B1||Service Not Eligible for Payment When Delivered by Telephone|
|B2||Paid in accordance with the OHIP Schedule of Benefits for Telephone Virtual Care Services|
|B3||Patient-Physician Relationship Requirements Not Met|
|B4||Virtual Service not allowed in addition to In-Person Equivalent Service|
|B5||In-Person Service Not Allowed in Addition to Virtual Equivalent Service|
|B6||Limited Virtual Care Service Already Paid|
|B7||Comprehensive Virtual Care Service Already Paid|
|B8||Service Not Eligible for Payment Virtually|
For a complete listing of Explanatory codes please see Remittance Advice Explanatory Codes/Messages.
Fee Schedule Master; FSM; fee schedule codes; virtual care; telephone; video; technical bulletin; physicians; vendors; OTN