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Information for Medical Care Plan (MCP) Providers

• TeleClaim Software
• Private Vendor's Software
• Communications Software
• Provider Audits
• Forms
• Physician's Information Manual
• Dental Information Manual
• Surgical Dental Payment Schedule
• Medical Care Plan (MCP) Medical Payment Schedule - 2013 (3.0 MB)
• Medical Care Plan (MCP) Medical Payment Schedule - 2009 (1.2 MB)
• Registration
• Claim Submission
• Claim Payment
• Newsletters
• On-Call Manual (267 KB)

Registration

Physicians who treat beneficiaries may submit claims for insured services directly to Medical Care Plan (MCP). Such claims must be in accordance with the established Medical Care Plan (MCP) Medical Payment Schedule (1.2 MB) and will be processed by Medical Care Plan (MCP) against established claim assessment rules.

All providers who wish to bill the Medical Care Plan or the Dental Health Plan must register with Medical Care Plan (MCP) by submitting a completed Provider Registration Form (83 KB). This form can be used for the initial registration, as well as for changes to registration information or re-activation of a previous registration.  A guide (36 KB) for completing the form is also available.

Before a physician can be registered with Medical Care Plan (MCP), licensure by the College of Physicians and Surgeons of Newfoundland and Labrador is required. Likewise, dentists must be licensed by the Newfoundland and Labrador Dental Board before being registered with Medical Care Plan (MCP).

Providers who are registered with Medical Care Plan (MCP) will be assigned a billing number which must be recorded on all claims submitted for payment.

Payment of claims is made in accordance with the Medical Care Plan (MCP) Payment Schedule which is established under the Medical Care Insurance Physicians and Fees Regulations. Physician's Fees are established in consultation with the Newfoundland and Labrador Medical Association. Dentist's fees are established in consultation with the Newfoundland and Labrador Dental Association.

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Claim Submission

Medical Care Plan (MCP) has established 26, two-week processing cycles during the fiscal year for the submission and processing of provider claims. The end of each two-week cycle is marked by a cut-off date, or deadline, for the receipt of claims. Providers can submit claims at any time during a cycle. The list of claim cut-off dates for the upcoming year is distributed to providers through an Medical Care Plan (MCP) Newsletter.

Providers who wish to submit claims electronically must complete and submit an Electronic Billing Application (41.0 KB).

Providers submitting claims to Medical Care Plan (MCP) may use private vendors' billing software, or Medical Care Plan (MCP)'s TeleClaim Software, to prepare and reconcile claims. The software package chosen must use file formats that conform to Medical Care Plan (MCP)'s specifications for electronic file transmissions. In addition, electronic submission will require installation of Medical Care Plan (MCP)'s Medical Care Plan (MCP)Connect / Medical Care Plan (MCP)Subsys software, a communication package which is provided free of charge.

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Claim Payment

All claims which are accepted for payment will be paid to the provider through electronic bank deposit, on a payday three weeks from the cut-off date. A remittance statement will be produced for each provider that details each claim that was processed and paid. Providers will receive their remittance statements in an electronic format. The list of claim payment dates for the upcoming year is distributed to providers through an Medical Care Plan (MCP) Newsletter. Providers may assign their payments to another provider, group, or hospital by submitting a completed Assignment of Payment Agreement (73.0 KB) to Medical Care Plan (MCP).

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Newsletters

When necessary, Medical Care Plan (MCP) publishes and distributes Newsletters to providers. Normally, each Newsletter concerns a specific topic and may or may not be sent to all providers, depending on the relevancy of the issue to certain specialties or groups of providers.

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