February 16, 2024
A member information session was held on February 16. Information was provided about the good faith claims process, including patient eligibility, how to submit new claims, how to submit for past claims that were rejected because of patient ineligibility and what steps physicians and their teams will need to take before submitting. Here is an anonymized summary of questions and answers.
What if the patient’s AHCIP coverage has expired or their record shows no coverage, but they still have an AB driver’s license?
Double check their registration status, if they are still not registered, you may submit a good faith claim for the date of service.
How do I show this is a good faith claim?
Be sure your billing software has been updated, and now contains a field called “Good Faith Claim Indicator”. When submitting your Good Faith claim, that indicator must be set to “Y”, and the additional claim details mentioned above included.
Do I need to delete previous claims to submit a new good faith claim?
Only claims that have an APLY claim result or paid at $0 need to be deleted. Claims with a RFSE claim result do not need to be deleted before submitting a good faith claim.
Can I resubmit any claims that were not submitted under good faith initially and were refused for invalid AHCIP coverage?
If it has been some time since you submitted these claims, please follow the steps to verify coverage. If you still believe that the patient is an eligible patient and would be eligible for AB coverage, you may submit a GF claim.
How do I claim if the patient’s AHCIP coverage has lapsed?
Double check their eligibility for coverage on the date of service through Alberta NetCare; if they do not have coverage: Submit a good faith claim; Be sure to include the patient’s full name, DOB, address and postal code (NOTE: do not use any punctuation when claiming).
Must the address be filled out in the claim? Most unhoused patients have no address and some do not stay at shelters.
The address portion MUST be completed to receive payment. The recommendation to use the shelter address is for the purpose of completing the address segment of the claim; the address of a community agency where the patient has connections could also be considered.
How do I claim for a newborn?
Do not make a good faith claim. If mom is an Alberta resident, claim under the mom’s health insurance number – see page 44 of the Physician’s resource guide - Open Government (alberta.ca). If mom is resident of another province (excluding Quebec), claim under mom’s other provincial health number– see page 57 of the Physician’s resource guide
Where do I find contact information for other provincial health departments to verify patient coverage?
See pages 58 and 59 of the Physician’s resource guide
NOTE: It is important to check eligibility for residents of other provinces and bill the other province where possible before making a good faith claim.
If I settled or otherwise dismissed 05A refused claims, how can I recover the information to submit to AH?
Contact your billing software provider regarding availability of a report detailing these rejected claims.
How do I document efforts to confirm patients’ coverage?
Note efforts to confirm in the patient’s record. AMA recommends you save or document communication with the patient, AHS and/or other provincial health departments in the patient's record.