Bulletin 230802 — PSA related Medical Claims Adjustment: Release 4
Update: Claim submissions for Z403 will be reprocessed by a Medical Claims Adjustment
To: All Physicians
Category: Physician Services
Written by: Claims Services Branch; Health Programs and Delivery Division
Date issued: August 21, 2023
Bulletin number: 230802
The Ministry of Health and the Ontario Medical Association have been working together to implement the 2021 Physician Services Agreement.
As described in INFOBulletin 230310, permanent adjustments to fee codes within the Schedule of Benefits for Physician Services have been made effective April 1, 2023.
The payment rules for fee schedule code Z403 - Bone marrow aspiration and/or core biopsy were implemented July 1, 2023, with an effective date of April 1, 2023. As a result, a Medical Claims Adjustments (MADJ) is required to reprocess related claims.
No action is required on the part of the physician.
Medical Claims Adjustments (MADJ)
Claims already submitted for Z403 with service dates between April 1, 2023 and June 30, 2023 are subject to being adjusted by the MADJ. These claims will be adjusted in accordance with the Schedule of Benefits for Physician Services.
Adjustments will begin to appear on the August 2023 remittance advice (RA). Please 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 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 to zero with no payment impact but will report on the RA for reconciliation purposes.
Z403; Physician Services Agreement; PSA; Physician Payment Committee; Adjustments; Medical Claims Adjustment