• Home
  • About the Department
    • Branches and Divisions
      • The Corporate Services Branch
        • Audit and Claims Integrity Division

Audit and Claims Integrity Division

The Audit and Claims Integrity Division ensures that public health care funds are distributed appropriately to healthcare providers for services provided to beneficiaries of the Medical Care Plan (MCP) and the Newfoundland and Labrador Prescription Drug Program (NLPDP).

The division:

• manages and administers Medical Care Plan (MCP), including the auditing of physician claims;
• manages and administers eligibility and registration services for Medical Care Plan (MCP) and NLPDP ;
• provides audit services for the Department;
• manages and administers the Inter-Provincial Reciprocal Billing Agreement and Eligibility and Portability Agreement related to Newfoundland and Labrador residents accessing health services in other provinces and other Canadian residents accessing health services in Newfoundland and Labrador;
• manages claims for Medical Care Plan (MCP) beneficiaries for medical travel assistance through the Medical Transportation Program;
• manages out-of country claims for Medical Care Plan (MCP) beneficiaries;
• identifies medical and hospital expenses incurred by residents due to negligence of a third party;

The units which provide these services include: Insured Services; Medical Audit and Compliance; Programs Audit; Medical Care Plan (MCP) Public Service and Administration; NLPDP Assessment (Stephenville); Medical Affairs and Training; Claims Assessing; and Claims Processing.

Contact Information