Term: Physician Claims

Glossary Definition

Last Updated: 2013-03-25


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.

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