Every province and territory publishes a schedule of benefits for insured physician services, and each updates it from time to time. Changes can add or retire fee codes, adjust values, or change the rules for how and when a code may be claimed. Most changes will not touch your practice. The few that do can affect your income and your claim rejections for months if they are missed.
This checklist is a way to review any update quickly and consistently.
1. Go to the official source
Read the bulletin or notice issued by your provincial health insurance plan, not a summary of it. In Ontario that means the Ministry of Health's OHIP bulletins and the Schedule of Benefits itself. Note the effective date of each change.
2. Start with the codes you bill most
Pull a report of your 20 most-billed codes from your EMR or billing software. Check each against the update. This usually covers most of your billing volume.
3. Look for rule changes, not only fee changes
Changes to eligibility, time requirements, documentation requirements or limits on frequency often matter more than changes in value, because they cause rejections.
4. Update templates and tell your team
- Update billing templates and favourites in your EMR before the effective date.
- Brief your billing agent or office manager, and anyone else who submits claims.
- Watch your remittance advice closely for the first two cycles after the change.
5. Know where to get help
Your provincial medical association and your billing software vendor usually publish guidance after major updates. For questions about a specific claim, contact your provincial plan directly.
Articles on medical.ca are written for health professionals. They are general information and do not replace your own clinical judgment, your regulatory college's guidance or advice from a lawyer or accountant.