What is Teleplan?
BC's medical and health care practitioners are able to submit their MSP claims for services provided for insured patients through a computerized system called Teleplan. Teleplan automates the submission and payment of medical claims, making it easier for physicians and health care professionals to complete their billing and for the governing body to process and make payments.
Healthcare providers that may qualify to submit bills to MSP
Medical practitioners in the following categories are able to submit all, or at least some, of their MSP claims through Teleplan:
- general physicians and specialists (such as anesthesiologists, internists, obstetricians and gynecologists, psychiatrists, surgeons, etc.)
- physiotherapists, chiropractors, registered massage therapists, and acupuncturists,
- dentists, podiatrists, optometrists, and ophthalmologists,
- naturopaths, midwives,
- other medical professionals such as nurse practitioners,
- and medical office staff, under the direction of the medical practitioner.
Claims that have been submitted must meet MSP's requirements for patient coverage in relation to services provided.
Submitting MSP, ICBC, and WorkSafeBC claims through Teleplan
Physicians and other care providers are able to submit their claims to Teleplan using medical billing software like ClinicAid. After submitting their invoices for medical services provided, medical professionals will receive a payment statement back from Teleplan in what's known as a remittance file. This remittance file will provide physicians with an assessment of all of the claims they've submitted, will show what the payment for each claim will be, and will also identify any claims that have been rejected and the reason for the rejection.
Teleplan can also be used to instantly check whether or not a patient is covered through the BC Medical Services Plan so that physicians know whether to bill MSP, the patient themselves, or a third party insurer.
Claims for third party insurers, such as the Insurance Corporation of BC (ICBC) and the Workers' Compensation Board (WorkSafeBC, formerly known as WCB), can also be submitted through Teleplan in most cases.
How MSP claims are processed
More than 5 million claims are processed through Teleplan on a monthly basis, equivalent to over $115 million dollars in payment. These claims all go through Teleplan's processing procedure that consists of 4 steps.
Step 1: Teleplan pre-edit of MSP claims
In this step, claims are verified to ensure the valid codes and values have been entered in the required fields of a claim. The MSP billing number of the care provider is also verified to match the data centre number of the submitter.
If any of these requirements aren't met, Teleplan will reject the claim and return it to the submitter electronically, along with a rejecting code explaining why the claim has been rejected. This step occurs automatically on a nightly basis for more than 250,000 claims.
Step 2: Teleplan eligibility edit for MSP claims
This step continues the verification process through a more detailed look at claims. This is when the patient information is verified, along with whether or not the provider is able to bill for that particular service, and whether or not the amount billed is the same as the fee amount determined by the MSP Payment Schedule.
If any of these requirements are incorrect, the claim is returned to the submitter. Claims can then be modified to provide the correct information and then re-submitted in most cases. This verification also runs nightly.
Step 3: Teleplan adjudication for MSP claims
The adjudication step assesses each claim using over 5,000 automated payment rules. In this step, claims are verified to ensure that they meet any conditions that may be applicable. Any claims that are incorrect may either be adjusted or rejected and are sent back to the submitter with an explanatory code. This process runs twice a month only.
About 97% of submitted claims are assessed in this way, with the remaining 3% done manually.
Step 4: Teleplan payment and remittance for MSP claims
In this final step, the millions of claims that are submitted from the thousands of health care providers in BC are paid out. Any adjustments, retroactive payments, or changes are applied and a remittance file is sent to submitters with an overview of the final assessment of each claim submitted.
This step also occurs twice a month, with payments being issued out shortly after the remittance file is sent.
The MSP billing cycle in BC for physicians and other care providers
There are three components of an MSP billing cycle:
- cut-off date - the start of the billing cycle, determined by MSP's Teleplan system. Claims submitted by the cut-off date will begin the processing procedure. Any claims submitted after a cut-off date will wait to be processed in the following billing cycle.
- remittance date - usually occurs 7 business days after a cut-off date, once the claims submitted before cut-off have completed the processing procedure. This is when practitioners are sent their remittance files with details regarding their paid, adjusted, or rejected claims.
- payment date - usually occurs 2 business days after a remittance date. Payment will be sent to the care provider via their preferred method (cheque or direct deposit) on this day, usually towards the middle and end of each month.
A billing cycle lasts approximately two weeks* before repeating. MSP issues new calendar dates for the billing cycle every year. Here is the MSP billing schedule for 2015.
* The majority of claims that BC's doctors and medical professionals submit are processed and paid out within 14 days, with 95% of all claims being processed within 30 days of submission. Processing times may vary depending upon the timing of submissions and the complexity of a claim.