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Cleft Palate & Craniofacial Resources

We help children and teens born with cleft palates and other disorders of the face and head.
MSP billing process

This page outlines the process for submitting MSP billing for the orthodontic care of patients with cleft lip/palate or other craniofacial anomalies. These instructions are applicable for all eligible patients within British Columbia.

Tips and troubleshooting

  • Only certified specialists in orthodontics can submit MSP billing for cleft and craniofacial patients.
  • If you have a previous MSP number from work as a general dentist, you will need to apply again as a certified specialist.
    • You will received a second MSP number for billing as a certified specialist.
  • You need to complete this step for every billing code that you wish to submit.
  • This means re-submitting for each exam, phase of treatment etc.
  • Any billing form (Step 5) which was not preceded by a matching form 2839 is likely to be declined.
  • Fill out form 2839 (PDF download)
    • Tip: Save a copy of this form with your information filled in to save time.

Instructions:


  • Complete Section 1 (patient information), Section 2 (orthodontist information), and Section 3 (indicate if patient has cleft lip/palate, or a different syndromic craniofacial diagnosis).
  • Use the MSP Schedule C (Orthodontics) fee guide (PDF download) to identify the appropriate code and fees for your patient.
  • Complete one of the "treatment" sections.
    • For patients with cleft lip and palate, complete Section 4 using the treatment phase and complexity definitions outlined in the fee schedule.
    • For patients with syndromic craniofacial diagnoses, complete Section 5 using the treatment phase and complexity definitions outlined in the fee schedule.
    • If no treatment is being performed (ie: examination only), describe the reason for examination and findings in the treatment plan box instead.
    • Treatment commencement and retention dates can be estimated if they are in the future.
  • Complete Section 6 with the appropriate fee codes.
    • Any fee codes which are not in 'A. Preparatory Procedures' should be written into 'B. Treatment Procedures'.
    • Confusingly, this includes codes such as between-phase observations or serial extraction guidance.

Understanding Coverage Eligibility

 

  • MSP coverage for orthodontic treatment can be confusing. It is NOT tied to a specific diagnosis.
  • Orthodontic coverage is generally available for patients with:
    • Iatrogenic malocclusion resulting from a medically necessary surgical intervention
      • Patients who had surgical repair of cleft lip/palate fall into this category. Note that this means that patients with clefts that did not require surgery (ex: submucous cleft palate) are typically NOT eligible for coverage.
    • Patients with congenital craniofacial syndromes who require orthognathic surgery.
      • Coverage may also be approved for these patients when the goal of orthodontic treatment is to prevent the need for future orthognathic surgery.
      • In Section 5, ensure that you clearly explain the relationship between your treatment and the need for current or future orthognathic surgery.
  • Understanding these eligibility criteria will help you speak with patient families regarding whether their treatment is likely to be covered or not.
 

Attach team report

 

  • Coverage requests must be accompanied by the most recent Cleft and Craniofacial Team report.
    • MSP uses this to confirm eligibility for coverage
  • If you do not have a copy of your patient's most recent team report, contact the responsible team:
    • BCCH Cleft and Craniofacial Team: 604-875-3146
    • Kelowna Cleft Team: 250-469-7070, ext. 12122
    • Island Cleft Team: 250-519-5390, ext. 36329
  • In rare instances when patients have not been seen for a team visit, a referral letter from a Cleft/Craniofacial Team member requesting your treatment of the patient may be used instead.

Submit to MSP

 

Send form 2839 (PDF download) and the team report together to:

 

MSP, ATTN: Orthodontics

Fax: 250-405-3588

Alternative Fax: 250-405-3590

 

Once your request is reviewed, you will receive confirmation from MSP detailing what coverage is approved:




Understanding the coverage confirmation


  • Approved fee codes for Preparatory Procedures (examination, diagnosis, treatment planning) are listed in the first box
  • Approved fees for treatment phases are generally split into four parts: one at initial bonding (noted in the top right box), and three quarterly fees (noted in the bottom box)
Additional information

  • You do not need to wait for coverage confirmation before submitting billing (Step 5).
  • However, we recommend waiting for coverage confirmation before initiating active treatment, unless the patient/family have committed to cover fees out of pocket if coverage is not approved.
  • Ensure that your contact information is correct and up to date with MSP.


 
  • Fill out form 1918 (PDF download)
    • Form 1918 is read with a document reader. 
    • It must be filled out electronically, and submitted by mail.
    • Do not enter the '.' between the dollars and cents of the fee, or the form will truncate your entry.
  • Complete the Patient Information section
    • You may leave blank: MVA related, MVA Claim Number, Correspondence Attached, and Plan Reference Number
  • Complete the Services section
    • You may leave SCC, Called Start, and Rendered Finish blank
    • Leave the tooth chart blank
    • Enter  'A' for Location of Services for all items
    • Enter the appropriate ICD9 Diagnostic Code (PDF download) for your patient on each item
    • Enter the Billing Code(s) which were requested/approved on Form 2839 in the Fee Item columns, and the corresponding fee in Amount Billed
      • Use the fee listed on the coverage confirmation where available. When not supplied, use the fee from the Schedule C Fee Guide (PDF download)
      • Do not enter the '.' between the dollars and cents of the fee, or the form will truncate your entry
  • Complete Practitioner Information Section
    • You may leave the 'Referred by' sections blank
    • The specialty code for orthodontists is '42'

Ensure Service Dates are correct and match Form 2839

 

  • For Initial Examination, enter the date of the examination, and ensure it matches Form 2839
  • For Diagnostic and Case Analysis codes, enter the date that records were obtained and/or evaluated
  • For the initial bonding/first treatment fee, enter the date that appliances were placed
  • Ensure this date is not prior to the Date of Commencement of Treatment you entered on Form 2839, or your billing may be declined
  • All of these billings can be submitted together on a single Form 1918 to save time

Billing Extended Treatment/Recurring Items

 

  • For subsequent quarterly fees, submit a new Form 1918 at 3 month intervals until all of the quarterly fees have been paid
  • On each subsequent form, enter the Service Date at 3 month intervals from the initial bonding/first treatment fee
  • If you enter an earlier date than the 3 month interval, your billing may be declined
 
  • You will receive a report on the status of your billings approximately every 2 weeks, so long as you have active or pending billings.
  • Review the report carefully for discrepancies between the Billed and Paid amounts to identify any cases where your billing has been declined:



  • Adjusted or declined items will be accompanied by explanatory codes (PDF download). MSP publishes a guide for understanding these codes,
  • Some explanatory codes, such as BH, do not require action on your part.
  • Some explanatory codes will describe an error made in the submission; you will need to resubmit.
Still Having Trouble with MSP Billing?

Contact the MSP Orthodontic Program for assistance:

Coleen Hadley
250-405-4260
 


Contact information

If you have any suggestion for improving this information, or if you are having trouble with it, please contact the author at: travis.gibson@cw.bc.ca.

If you would like assistance with the clinical orthodontic management of a cleft or craniofacial team patient, please reach out to one of the BCCH Cleft and Craniofacial Team orthodontists.

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