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Ministry Status: Routine Monitoring and Engagement

Ontario Health Insurance Plan

OHIP Bulletins

Primary Health Care Services InfoBulletins

To:  GP Focus Care of the Elderly – Model 1 Physicians

Published by:   Negotiations Branch

Date Issued:  August 11, 2016

Bulletin Number:  11156

Re:   COE Agreement Automation (Model 2 – Phase 2 Implementation)

PDF Version Portable Document Format

In late 2013, Phase 1 of the GP Focus Care of the Elderly – Model 2 (COE1) agreement was implemented onto the Ministry Claims Payment System (MCPS) enabling COE physicians to submit claims using their COE group identifier/billing number. As an interim process until the implementation of Phase 2 was possible, claims submitted were suppressed in MCPS and the data was used to calculate COE payments manually.

Effective August 1, 2016, Phase 2 of the COE – Model 2 agreement will be implemented. All COE payments will be fully automated onto MCPS and manual payments will no longer be required.

An explanation of the changes as a result of this implementation is provided below:

  1. Billing/Claims Submission – No Change
    • Physicians will continue to submit claims for all services provided while working as a COE1 physician using their four digit COE group identifier/billing number.
  2. Payments – Change
    • All payments and the corresponding discounts will be calculated and paid through the MCPS, reported on the COE group Remittance Advice (RA) and paid to the COE group bank account.
  3. Payment Delays – Change
    • The move from manual payments to automated payment through the MCPS means that there will no longer be a one month delay in claims related bonus and premium payments due to manual processing. (e.g. claims assessed in May are paid on the July remittance advice).
    • The September 2016 COE2 group RA will include all payments calculated by the MCPS for Base, Administration, Fee-for-Service and Shadow Billing Premium along with the corresponding discounts for the processing month of August.
    • Physicians who have previously received their COE payments on their solo remittance advice and paid into their solo bank account will receive their last manual payment in September for claims assessed in July 2016.
  4. Payment Reporting – Change
    • COE2 Group RA Reporting
    • The group RA will provide the group Lead with reporting to assist in dispersing payments to physicians in their groups.
    • Each payment element is provided with a breakdown by physician with month-to-date and year-to-date totals as well as group level reporting.
    • Cumulative year-to-date, current month, and new cumulative totals for both the Fee-for-Service Cap and After Hour Payment Thresholds will also be reported on the group RA.

    Solo RA Reporting

    • Each physician in the group will also receive their own payment information for each payment element reported on their own solo RA.

    For any inquiries please contact the Service Support Contact Centre: 1-800-262-6524 or ServiceSupportContactCentre@moh.gov.on.ca

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