Alberta Health has announced an important update as of February 6th, 2024. The option to submit Good Faith claims has been reintroduced, allowing for retroactive billing back to April 1, 2022. This update is significant for healthcare providers treating patients who are eligible for coverage in Alberta but lack immediate proof at the time of their appointment. If you’ve had claims rejected previously due to an “Invalid Personal Health Number” (code 05A), you can now resubmit them for payment, assuming all other criteria are met.
The process for submitting these Good Faith claims has been streamlined to bypass manual checks, making it faster and less cumbersome for providers. This applies to services delivered in both Alberta Health Services (AHS) facilities and community practices. The coverage includes care for eligible Alberta residents not yet registered under the Health Insurance Premiums Act and for patients from other provinces or territories with mutual recognition agreements, provided they’re covered by their home province’s or territory’s health plan but haven’t presented a valid card.
Understanding Patient Eligibility
Not all individuals may qualify for Good Faith claim reimbursement, particularly those not covered by the Alberta Health Care Insurance Plan (AHCIP) or another provincial or territorial health insurance plan. Physicians seeking to understand how to submit claims for services provided to these individuals should consult the latest AHCIP Bulletin for guidance.
Submitting New Claims
For new claims, ensure you include the following details:
- Claim Information: Include the practitioner ID, health service code, date of service, diagnostic codes, modifiers, facility number, and business arrangement. Mark the Good Faith Indicator field as “Y
“..” Leave the Service Recipient ULI and Registration number fields blank. - Patient Details: Record patient’s last name, first name, date of birth, gender, and full address without using dashes, abbreviations, or punctuation to avoid claim refusal.
To expedite your claim’s processing and payment, only add text to your claim if it’s specifically required by the health service code.
Submitting Past Claims
For past claims, it’s important to note that Good Faith claims are only payable once per patient per physician. Additionally, if you submit more than one claim for the same patient, the system will return it with a different explanatory code, 01C, indicating the duplication.
To resubmit a claim:
- Search your EMR for records from April 1, 2022, onwards
. - Identify claims rejected with error code 05A.
- Verify the information is accurate.
- Resubmit the corrected claim to AHCIP.
Before You Submit
Before submitting Good Faith claims, ensure you’ve taken steps to verify the patient had valid coverage at the time of service. This can be done through:
- Calling Alberta Health’s IVR service at 1-888-422-6257.
- Using Alberta Netcare for coverage verification.
- Consulting ADT/CIS systems like Connect Care or Meditech.
- Contacting the facility’s registration or health records department.
If coverage verification fails but eligibility is still believed, documentation supporting this conclusion must be provided to Alberta Health upon request.
Assistance with Past Claims
For those seeking help with correcting these errors and resubmitting past claims, ClinicAid can do it for you! For a limited time, we are offering retroactive error correction to customers that sign up for our rejection handling service for $150/month. Registering for ClinicAid’s service can streamline the correction and resubmission process, ensuring you receive the reimbursements you’re entitled to.
Complete this form to register for ClinicAid’s rejection handling service today!
