A-29, r. 7.2 - Regulation respecting the terms and conditions for the issuance of health insurance cards and the transmittal of statements of fees and claims

Section 31 Disposition versions

2018-06-28

31. (Revoked).

R.R.Q., 1981, c. A-29, r. 2, s. 31; O.C. 413-85, s. 7; O.C. 655-86, s. 1; O.C. 1178-86, s. 8; O.C. 553-87, s. 6; O.C. 1289-96, s. 1; O.C. 659-2018, s. 19.

2016-01-01

31. Billing statement — physicians, dentists and optometrists: For physicians, dentists and optometrists, the billing statement produced manually or by computer equipment or hardware, must contain the following information:

(a)  in accordance with technical specifications in the manual, a reference number for the sending of information forwarded to the Board by means of magnetic recording media or by telecommunication, which must appear on each page;

(a.1)  in accordance with technical specifications in the manual, an external check number identifying each statement of fees or request for payment, as the case may be;

(b)  the insured person’s Health Insurance Number or, if not available, his given name and surname at birth, date of birth and sex;

(c)  the number and, if applicable, the group number of the accredited professional;

(d)  the number or, if not available, the initial and surname of the health professional who requested a consultation or other insured services from the health professional submitting the claim;

(e)  the diagnosis and an indication of any service rendered within the framework of legislation administered by the Commission des normes, de l’équité, de la santé et de la sécurité du travail;

(e.1)  where the service was rendered within the framework of legislation administered by the Commission des normes, de l’équité, de la santé et de la sécurité du travail, the date on which the occupational injury or occurrence took place;

(f)  any information required by the Board to evaluate services claimed, such as roles, modifiers, units;

(g)  the number of the institution, if applicable, or, where services were provided by a physician outside an institution, the number of the locality based on the codes assigned by the Board;

(h)  the date of the insured person’s admission to an institution and the date of discharge, if applicable;

(i)  the date on which the service was rendered;

(j)  the code of the procedure claimed and the relevant fees;

(k)  the number of kilometers and the amount reimbursable under the agreement;

(l)  all fees demanded;

(m)  the signature of the accredited professional or of the duly authorized mandatary, as the case may be.

Notwithstanding the foregoing, for physicians and dentists remunerated by way of fixed fees or salary, and for physicians and dentists remunerated by way of fees for a fixed price of fees, the billing statement produced manually or by computer equipment or hardware must contain the signature of the physician or dentist, as the case may be, or the signature of his duly authorized mandatary, in addition to the signature of the person duly authorized by the institution at which the professional provided the service for which he is submitting the statement of fees, as well as, if they are forwarded, the elements referred to in section 9.2 or 9.3, as the case may be, and the following elements:

in accordance with the technical specifications in the computerized billing instructions forwarded to the physician or dentist, the data corresponding to the following identification or forwarding coordinates:

(1)  a reference number for the sending of information forwarded to the Board by means of magnetic recording media or telecommunications media, which must appear on each page;

(2)  the number of the data processing agency, where applicable;

(3)  the system code and the record code used for forwarding data;

(4)  the attestation number for the consignment of requests for payment;

(5)  indications of the beginning and end of the forwarding of data.

R.R.Q., 1981, c. A-29, r. 2, s. 31; O.C. 413-85, s. 7; O.C. 655-86, s. 1; O.C. 1178-86, s. 8; O.C. 553-87, s. 6; O.C. 1289-96, s. 1.

2012-09-01

31. Billing statement — physicians, dentists and optometrists: For physicians, dentists and optometrists, the billing statement produced manually or by computer equipment or hardware, must contain the following information:

(a)  in accordance with technical specifications in the manual, a reference number for the sending of information forwarded to the Board by means of magnetic recording media or by telecommunication, which must appear on each page;

(a.1)  in accordance with technical specifications in the manual, an external check number identifying each statement of fees or request for payment, as the case may be;

(b)  the insured person’s Health Insurance Number or, if not available, his given name and surname at birth, date of birth and sex;

(c)  the number and, if applicable, the group number of the accredited professional;

(d)  the number or, if not available, the initial and surname of the health professional who requested a consultation or other insured services from the health professional submitting the claim;

(e)  the diagnosis and an indication of any service rendered within the framework of legislation administered by the Commission de la santé et de la sécurité du travail;

(e.1)  where the service was rendered within the framework of legislation administered by the Commission de la santé et de la sécurité du travail, the date on which the occupational injury or occurrence took place;

(f)  any information required by the Board to evaluate services claimed, such as roles, modifiers, units;

(g)  the number of the institution, if applicable, or, where services were provided by a physician outside an institution, the number of the locality based on the codes assigned by the Board;

(h)  the date of the insured person’s admission to an institution and the date of discharge, if applicable;

(i)  the date on which the service was rendered;

(j)  the code of the procedure claimed and the relevant fees;

(k)  the number of kilometers and the amount reimbursable under the agreement;

(l)  all fees demanded;

(m)  the signature of the accredited professional or of the duly authorized mandatary, as the case may be.

Notwithstanding the foregoing, for physicians and dentists remunerated by way of fixed fees or salary, and for physicians and dentists remunerated by way of fees for a fixed price of fees, the billing statement produced manually or by computer equipment or hardware must contain the signature of the physician or dentist, as the case may be, or the signature of his duly authorized mandatary, in addition to the signature of the person duly authorized by the institution at which the professional provided the service for which he is submitting the statement of fees, as well as, if they are forwarded, the elements referred to in section 9.2 or 9.3, as the case may be, and the following elements:

in accordance with the technical specifications in the computerized billing instructions forwarded to the physician or dentist, the data corresponding to the following identification or forwarding coordinates:

(1)  a reference number for the sending of information forwarded to the Board by means of magnetic recording media or telecommunications media, which must appear on each page;

(2)  the number of the data processing agency, where applicable;

(3)  the system code and the record code used for forwarding data;

(4)  the attestation number for the consignment of requests for payment;

(5)  indications of the beginning and end of the forwarding of data.

R.R.Q., 1981, c. A-29, r. 2, s. 31; O.C. 413-85, s. 7; O.C. 655-86, s. 1; O.C. 1178-86, s. 8; O.C. 553-87, s. 6; O.C. 1289-96, s. 1.