Alberta Health claims

Alberta Health claims

The importance of Alberta Health claims cannot be overstated, as they are crucial for running a clinic. Without these claims, the clinic would be unable to compensate its staff, doctors, and supply necessary equipment.

To complete the claim cycle, there are a few steps, starting with creating and submitting. There will also be times when reconciling claims is also required.

 

The Billing Cycle

The Alberta Health Care Insurance Plan (AHCIP) billing period starts on Thursdays and ends on Wednesday the following week.  Claims that were entered during this time will be sent to Alberta Health when you submit your claims on Wednesdays. The cut-off for submissions is midnight every Wednesday.

Reconciliation files will be available for download on Monday of the following week.

 

Updating the Schedule of Medical Benefits (SOMB) data

Healthquest has datasets that include all the different codes (diagnostic, service, modifiers), that get updated as Alberta Health makes changes to the SOMB. It is important to make sure these codes are always up to date so that submitted claims have the best chance of being paid correctly.

 

To update the Alberta Health datasets, click on setup > load AH tables.

*Note, ‘Load AH fee modifier codes table’, ‘Import HQ service codes table’, and ‘Import HQ service/modifier table’ will be selected.

  1. Select any other tables that are applicable to your clinic.
  2. Click ‘go’.
  3. Click yes to the pop up.
  4. A message will appear stating ‘all tables successfully loaded’, click ok.

 

Best practice is to upload these tables on a regular basis, every three months, or when seeing a notice on the security new feed stating new Alberta Health tables have been uploaded.

Browsing AH Tables

Healthquest allows you to browse the service codes used in AH claims.  This can be useful when you need to verify that a specific service code amount will be increased for specific skill codes and fee modifiers.  You can see how calls and encounters affect the amounts charged, as well as determine percentage increases to service code amounts.

  1. Click on the Browse menu and choose AH Tables.  The Browsing AH Supplied Tables window opens:

  1. Choose the code type that you would like to display, and how you want to perform the search (code order or keyword).
  2. Enter a starting value into the Start Value field and press the Start button.  Healthquest will display the records based on the code or keyword you entered.

  

Importing Referral Doctors

A quick way to load referral doctor cards is to import the practitioner list from the AH control tables, select ‘Import from practitioner ID extract report’.

  1. Click go, then select the type of referral doctor you wish to download.


  1. Select ‘skip practitioner IDs already in Healthquest’ or ‘Add address for practitioner IDs already in healthquest’.
  2. Click ok to import.
  3. A popup message will display when the import is complete, click ok.
  4. Click the exit button to close the Import AH Control Tables window.


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