Alberta’s healthcare landscape is evolving with the introduction of the Primary Care Physician Compensation Model (PCPCM) – a new payment structure developed to better reflect the full range of care provided by family physicians. This model offers an alternative to the traditional Fee-For-Service (FFS) system by moving away from a volume-based approach and instead focusing on continuity, patient complexity, and the time spent delivering both direct and indirect care. 

For physicians using ClinicAid to manage their Alberta Health claims, understanding how this new structure works is essential to ensure correct claim submissions and to make the most of available compensation opportunities. This blog outlines the components of the PCPCM and explains how ClinicAid supports physicians through the transition, ensuring accurate submissions and optimized revenue. 

What is the PCPCM? 

The PCPCM supports comprehensive, long-term care by recognizing both direct patient interactions and the administrative and coordination tasks physicians perform. 

Compensation under the PCPCM is divided into three primary components: 

This blended model enables physicians to align their earnings more closely with the full scope of their work, with projected increases in annual income of up to 25%. 

Billing for Patient Encounters Under Alberta’s PCPCM 

Under PCPCM, many commonly used billing codes fall into a defined “in-basket” category and are reimbursed at 68.5% of the usual FFS rate. For example: 

All services not included in the in-basket list are considered out-of-basket and paid at 100% of the FFS rate. These can be submitted to AHCIP with applicable complexity modifiers.  

Services that fall outside the in-basket category, such as certain procedures or home visits, are considered out-of-basket and continue to be paid at 100% of the standard FFS rate.  

Examples include: 

ClinicAid Note: Out-of-basket services are still billed through your FFS Business Arrangement (BA). To do that, you would need to update the claim by going to the “Advanced” tab or selecting your FFS provider record, which is already set up within ClinicAid. 

How to Bill for Time-Based Services Under Alberta’s PCPCM 

A key aspect of PCPCM is the introduction of time-based billing, which includes patient interactions as well as non-patient-facing work such as reviewing test results or coordinating care with other providers.  

Time is billed in 15-minute increments and tracked cumulatively across the day. Physicians must submit claims within 90 days of service. There is also an annual cap on after-hours time billing, set at 20% of total claimed hours. 

Physicians also receive a 10% practice management fee, which is automatically calculated based on the total reported hours. For example, a 50-hour care week earns an additional $525. 

To submit these claims, physicians must use a PCPCM Business Arrangement (BA). Time-based submissions under a standard FFS BA will be rejected by AHCIP. 

Important: Time-based billing is only eligible for care provided to panelled patients. Be sure your patient panel is current and uploaded via CPAR. 

ClinicAid Note: Please refer to this guide to learn how to create a secondary PCPCM provider record in ClinicAid. 

Overview of PCPCM Time Codes 

Physicians can claim time, including time with out-of-province patients, when the majority of patients seen during the day are part of their panel. 

Direct Care codes (PC001, 003, 004) cannot be claimed for time spent on out-of-basket services and exclude services and encounters with out-of-country patients. Up to 20% of total time-based billing per fiscal year can be assigned to premium-rate Direct Care Codes (PC003 and PC004). 

Time Code	Usage	Rate (per 15 minutes)	Eligible Activities
Direct Care (PC001)	Monday – Friday 7am to 5pm excludes holidays Max calls per day: 40	$26.25	Direct care to patients: In-person Video Phone Charting between appointments that took place between 7am and 5pm on weekdays
Indirect Care (PC002)	Unrestricted Max calls per day: 44	$26.25	Indirect care   Reviewing labs, consultations with specialists, and completing referral forms/letters Batch charting after the clinic day is over Asynchronous communication with patients, including secure messaging, email, etc Completing forms (excluding third-party forms or forms related to paid services)  Case management activity between providers, where the patient or family members aren’t involved    The patient does not have to be present in the clinic or have an encounter with the physician on the same day. Claims are not limited to services found in the SOMB.
After-Hours Direct Care (PC003)	Monday – Friday 5pm to 11pm excludes holidays Max calls per day: 24	$48.18	Direct care to patients: In-person Video Phone (urgent) Charting between appointments that took place between 5pm and 11pm on weekdays
Weekend & Holiday Direct Care (PC004)	Weekends & Holidays 7am to 11pm Max calls per day: 64	$48.18	Direct care to patients: In-person Video Phone (urgent) Charting between appointments that took place between 7am and 11pm on weekdays

ClinicAid Note: If you are billing more than one call, you will need to indicate that under the “Calls” field.

Monthly Panel-Based Payments 

The PCPCM also includes monthly panel payments, which account for 20% of total compensation. These are calculated based on both the size and complexity of a physician’s patient panel using CIHI’s Population Grouper methodology. 

To ensure accurate payment, physicians must upload their patient panel to CPAR via their EMR between the 1st and 21st of each month. 

Maintaining an up-to-date panel is key to optimizing your capitation payments. 
Check the upload schedule by EMR. 

ClinicAid Note: While ClinicAid does not handle panel uploads directly, it is recommended that physicians coordinate with their EMR provider to ensure timely submissions.  

How ClinicAid Supports PCPCM Billing 

ClinicAid is equipped to help physicians submit both PCPCM and traditional FFS claims seamlessly. Whether you are billing for in-basket codes at the adjusted rate, managing time-based services, or continuing to submit FFS claims for out-of-basket services, ClinicAid can support your practice. 

Key features include: 

If you’re transitioning to PCPCM or billing under both models, our team is here to support you every step of the way. 

Need Help with PCPCM Billing? 

As Alberta continues to implement the new PCPCM model, staying informed and well-supported is key. If you have questions about configuring your ClinicAid account or need assistance with billing workflows, we’re here to help. 

Contact the ClinicAid team for personalized support or a walkthrough of PCPCM billing tools.