Term: Physician Claims

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Glossary Definition

Last Updated: 2013-03-25

Definition:

Also called physician billing claims or medical claims, physician claims data are stored in the Medical Services Database and contain information about ambulatory services: physician service information (which identify provider), type of service provided, when and to whom the service was provided, and the fee or tariff related to the service. Claims are submitted to the provincial government by individual physicians for services they provide. Fee-for-service physicians receive payment based on these claims, while those submitted by physicians on alternate payment plans (APP) are for administrative purposes only (sometimes referred to as "shadow billing").

NOTE: See the Medical Services Data glossary term for more information.

Related concepts 

• Adult Immunizations
• Physician / Hospital Claims
• Physician Consultation Visits

Related terms 

• Alternate Payment Plan (APP)
• Ambulatory Visits - Physician
• Claims
• Fee-For-Service (FFS)
• Full Time Equivalent (FTE)
• Global Billing
• Group Identifier Code (Site Code)
• Hospital Claims
• Magnetic Resonance Imaging (MRI) Scans
• Manitoba Population Research Data Repository (Repository)
• Medical Claims
• Medical Claims File
• Medical Remuneration
• Medical Services / Medical Claims Data
• Physician Claims File
• Physician Costs
• Physician Data
• Physician Service Claim
• Referral Index (RI)
• Shadow Billing
• Skin Ulcers
• Tariffs

References 

• Frohlich N, Katz A, De Coster C, Dik N, Soodeen RA, Watson D, Bogdanovic B. Profiling Primary Care Physician Practice in Manitoba. Winnipeg, MB: Manitoba Centre for Health Policy, 2006. [Report] [Summary] (View)
• Katz A, Martens P, Chateau D, Bogdanovic B, Koseva I, McDougall C, Boriskewich E. Understanding the Health System Use of Ambulatory Care Patients. Winnipeg, MB: Manitoba Centre for Health Policy, 2013. [Report] [Summary] (View)

Term used in 

• Brownell M, De Coster C, Penfold R, Derksen S, Au W, Schultz J, Dahl M. Manitoba Child Health Atlas Update. Winnipeg, MB: Manitoba Centre for Health Policy, 2008. [Report] [Summary] [Additional Materials] (View)
• Brownell M, Santos R, Kozyrskyj A, Roos N, Au W, Dik N, Chartier M, Girard D, Ekuma O, Sirski M, Tonn N, Schultz J. Next Steps in the Provincial Evaluation of the BabyFirst Program: Measuring Early Impacts on Outcomes Associated with Child Maltreatment. Winnipeg, MB: Manitoba Centre for Health Policy, 2007. [Report] [Summary] (View)
• De Coster C, Chateau D, Dahl M, Soodeen RA, McKeen N. Waiting Times for Surgery, Manitoba 1999/2000 to 2003/04. Winnipeg, MB: Manitoba Centre for Health Policy, 2007. [Report] [Summary] (View)
• Doupe M, Kozyrskyj A, Soodeen R, Derksen S, Burchill C, Huq S. An Initial Analysis of Emergency Departments and Urgent Care in Winnipeg. Winnipeg, MB: Manitoba Centre for Health Policy, 2008. [Report] [Summary] [Additional Materials] (View)
• Finlayson G, Reimer J, Dahl M, Stargardter M, McGowan K. The Direct Cost of Hospitalizations in Manitoba, 2005/06. Winnipeg, MB: Manitoba Centre for Health Policy, 2009. [Report] [Summary] [Additional Materials] (View)
• Fransoo R, Martens P, Prior H, Chateau D, McDougall C, Schultz J, McGowan K, Soodeen R, Bailly A. Adult Obesity in Manitoba: Prevalence, Associations, and Outcomes. Winnipeg, MB: Manitoba Centre for Health Policy, 2011. [Report] [Summary] (View)
• Fransoo R, Martens P, Burland E, The Need to Know Team, Prior H, Burchill C. Manitoba RHA Indicators Atlas 2009. Winnipeg, MB: Manitoba Centre for Health Policy, 2009. [Report] [Summary] [Additional Materials] (View)
• Garland A, Fransoo R, Olafson K, Ramsey C, Yogendran M, Chateau D, McGowan K. The Epidemiology and Outcomes of Critical Illness in Manitoba. Winnipeg, MB: Manitoba Centre for Health Policy, 2012. [Report] [Summary] (View)
• Heaman M, Kingston D, Helewa M, Brownell M, Derksen S, Bogdanovic B, McGowan K, Bailly A. Perinatal Services and Outcomes in Manitoba. Winnipeg, MB: Manitoba Centre for Health Policy, 2012. [Report] [Summary] [Updates and Errata] (View)
• Katz A, Bogdanovic B, Soodeen R. Physician Integrated Network Baseline Evaluation: Linking Electronic Medical Records and Administrative Data. Winnipeg, MB: Manitoba Centre for Health Policy, 2010. [Report] [Summary] (View)
• Katz A, Chateau D, Bogdanovic B, Taylor C, McGowan K-L, Rajotte L, Dziadek J. Physician Integrated Network: A Second Look. Winnipeg, MB: Manitoba Centre for Health Policy, 2014. [Report] [Summary] [Updates and Errata] (View)
• Katz A, Bogdanovic B, Ekuma O, Soodeen RA, Chateau D, Burnett C. Physician Resource Projection Models . Winnipeg, MB: Manitoba Centre for Health Policy, 2009. [Report] [Summary] (View)
• Katz A, De Coster C, Bogdanovic B, Soodeen R, Chateau D. Using Administrative Data to Develop Indicators of Quality in Family Practice. Winnipeg, MB: Manitoba Centre for Health Policy, 2004. [Report] [Summary] (View)
• Lix L, Smith M, Azimaee M, Dahl M, Nicol P, Burchill C, Burland E, Goh C, Schultz J, Bailly A. A Systematic Investigation of Manitoba's Provincial Laboratory Data. Winnipeg, MB: Manitoba Centre for Health Policy, 2012. [Report] [Summary] (View)
• Lix L, Yogendran M, Burchill C, Metge C, McKeen N, Moore D, Bond R. Defining and Validating Chronic Diseases: An Administrative Data Approach. Winnipeg, MB: Manitoba Centre for Health Policy, 2006. [Report] [Summary] (View)
• Martens P, Nickel N, Forget E, Lix L, Turner D, Prior H, Walld R, Soodeen RA, Rajotte L, Ekuma O. The Cost of Smoking: A Manitoba Study. Winnipeg, MB: Manitoba Centre for Health Policy, 2015. [Report] [Summary] [Updates and Errata] [Additional Materials] (View)
• Martens P, Fransoo R, The Need to Know Team, Burland E, Prior H, Burchill C, Romphf L, Chateau D, Bailly A, Ouelette C. What Works? A First Look at Evaluating Manitoba's Regional Health Programs and Policies at the Population Level. Winnipeg, MB: Manitoba Centre for Health Policy, 2008. [Report] [Summary] [Additional Materials] (View)
• Metge C, Chateau D, Prior H, Soodeen R, De Coster C, Barre L. Composite Measures/Indices of Health and Health System Performance. Winnipeg, MB: Manitoba Centre for Health Policy, 2009. [Report] [Summary] (View)
• Roos LL, Gupta S, Soodeen RA, Jebamani L. Data quality in an information-rich environment: Canada as an example. Can J Aging 2005;24 Suppl 1(Suppl 1):153-170. [Abstract] (View)
• Santos R, Brownell M, Ekuma O, Mayer T, Soodeen R-A. The Early Development Instrument (EDI) in Manitoba: Linking Socioeconomic Adversity and Biological Vulnerability at Birth to Children's Outcomes at Age 5. Winnipeg, MB: Manitoba Centre for Health Policy, 2012. [Report] [Summary] (View)