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Physiotherapy Facilities InfoBulletins

To: Physiotherapy Facilities

Published by: Claims Services Branch

Date Issued: May 17, 2017

Bulletin Number: 3137

Re: Reporting Requirements for ODSP-OW Patients

Posted Electronically Only

PDF Version Portable Document Format | 133 kb

This INFOBulletin replaces INFOBulletin 3115 - Physiotherapy Report - "D2 - ODSP/OW Clients Without OHIP Coverage".

The ministry is introducing changes to the reporting requirements for patients who are recipients of the Ontario Disability Support Program or Ontario Works. Effective April 1, 2017 all publicly funded physiotherapy clinics will be responsible for maintaining a list of patients that are recipients of the Ontario Disability Support Program (ODSP) or Ontario Works (OW) who either do not have valid health coverage or where the service encounter rejected with the error message "EPS - Patient Not Eligible for Program". The ministry will require this list be provided with the year-end settlement report and may also request a copy of this list at any time.

This list, which is to be sent by fax (do not submit this report to the ministry by email) to 613-536-3184, should be in a format such as MS Excel and must contain the following information:

  • Patient first and last name
  • Date of birth
  • Health number (if applicable)
  • ODSP/OW Client ID (if available)
  • Referring Physician or Nurse Practitioner 6 digit OHIP billing number
  • Service Encounter Codes
  • Diagnostic Code
  • Date of Service
  • Confirmation number provided by MCSS SAV helpline

Service encounter information for patients eligible for ODSP/OW who have a valid health number must be submitted through the Medical Claims Electronic Data Transmission (MC EDT) first. If the service encounters reject with the EPS error message then they are to be recorded manually on the list your clinic is maintaining for ODSP/OW patients.

Patients who are recipients of ODSP/OW must have their eligibility verified by the Ministry of Community and Social Services as outlined in INFOBulletin 3128 - Changes to the Way Social Assistance Recipients Access Coverage for Physiotherapy Services in Community Physiotherapy Clinics, dated December 2, 2016.

There will be a space on the D4 Year-End Settlement report (which will be provided to all clinics by May 30 each year) to report the number of discharges that were recorded manually for these patients. The D4 Year-End Settlement report is due to the ministry by June 30th of each year.

Effective March 31, 2017, the requirement to submit a D2 Report to the ministry for patients with service dates on or after April 1, 2017 is discontinued. A D2 Report is required for patients with service dates prior to April 1, 2017.

To view Portable Document Format PDF files, you will need to have Adobe Acrobat® Reader installed on your computer. You can download this free software from the Adobe website.

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