Medical Services Plan (MSP) Payment Information File

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Date range: April 1, 1985 onwards  (fiscal year files)

Data source: BC Ministry of Health

This checklist is historical and provided only for reference. Please refer to https://my.popdata.bc.ca/dar/ for the current application and checklists.


Description

Data on medically necessary services provided by fee-for-service practitioners to individuals covered by the Medical Services Plan (MSP), BC's universal insurance program. Practitioners are separated into: physicians, supplementary benefit practitioners (physiotherapists, massage practitioners, naturopathic physicians, etc.), and out-of-province practitioners.

Inclusions

  • All medically required services provided by fee-for-service practitioners, including laboratory and diagnostic procedures (x-rays, ultrasounds etc.), and dental and oral surgery performed in hospital.
  • Some additional billing information, e.g. no charge referrals, nurse practitioners, Primary Health Care encounters claims, and other encounter claims appear in the data as "shadow billings".
  • Payments made on behalf of BC residents who obtained services in Quebec, the U.S. and other countries are included. These payments appear in the MSP data because they have gone through the regular adjudication process. Please see the note under ‘exclusions' regarding services obtained in other provinces and territories in Canada.

Exclusions

  • Data on abortion procedures, including those conducted in concert with other procedures, are only available by special request. Requests must demonstrate how Therapeutic Abortion (TA) data is required to fulfill the research objectives by providing a strong rationale. The Ministry of Health will review requests and make a decision on release according to existing policy on a case-by-case basis. This is in accordance with the BC Freedom of Information and Protection of Privacy Act article 22.1.
  • Services provided through alternative payment plans, such as salaried, sessional, and service agreement contracts, etc. do not appear in the MSP payment files.
  • In April 2002, MSP stopped covering the majority of supplemental benefit services. These include: chiropractic, massage therapy, physical therapy, naturopathy, optometry, and podiatry services. These services are still provided in medically necessary cases for lower income individuals.
  • All provinces and territories (except Quebec) participate in ‘reciprocal billing agreements', where Canadians with coverage from other provinces or territories who receive services out-of-province are provided services without charge, and the providing province bills the services back to the home province. Records of these services are kept in a separate file (the "out of province services" file) and the amount of information collected is far less than what is included in the MSP Payment file. There are sometimes significant implications for understanding service use in areas bordering Alberta in particular, where it may make more sense for patients to receive care from a provider in Alberta rather than one in BC.
  • Population Data BC does not receive some payment adjustment fields in our data files. For most projects, this exclusion will have little meaningful impact.
  • All records that are associated with an ICBC or WorkSafeBC claim type are excluded from our standard MSP Collection (roughly 3.5 percent of MSP records; or 1.6 and 1.9 percent for WSBC and ICBC respectively). If the WorkSafeBC records in the MSP file are essential for your research, additional approval may be obtained from WorkSafeBC by selecting the option in the MSP data checklist when submitting the Data Access Request (DAR) to Population Data BC. Unfortunately, this option is not currently available for ICBC records.
  • Payments to physicians who perform WorkSafeBC expedited surgeries in public hospitals do not appear in the MSP Payment files. Expedited surgeries are paid at a different rate than what is specified in the MSP fee schedule and so are billed directly to WorkSafeBC.

Quality / Accuracy of Information / Field Coding Source

  • The majority of billing records are submitted electronically by practitioners' offices to MSP. MSP conducts audits/quality checks for select fields.
  • There are ICD (diagnosis) codes in this file. These are still collected in ICD-9 format. Up to five ICD-9 codes are included per record, and these are generally considered accurate only to the 3rd digit level. These codes have been shown to be valid at the population level (Hu 1996).

Important Additional Information

  • This file is originally organized as a payment date file, i.e. a record for each payment made during a fiscal year. Population Data BC reorganizes the file to provide researchers with the MSP payment data organized by the date services are provided. This is a more relevant organization for research purposes, but researchers should be aware that the most current year of MSP payment data available is approximately 5-10% incomplete. There can be up to a six month lag between when a service is provided and when payment for that service is made and a record entered into the MSP payment data. Some records for services provided in particular in the last quarter of the most current year may not show up in the payment data until the first quarter of the following fiscal year. For example, a record for a service provided on February 15, 2001 may not show up in the MSP payment data prior to March 31, 2001, which is the close of the data year. If the most current year of payment data available is 2000/01, the payment record for that service will not be included in the Population Data BC data holdings until the 2001/02 MSP payment data are available. >> more details
  • Similar to the situation described above, there are instances when retroactive payments are provided en masse to physicians, e.g. because of fee increases that are applied back in time. In this case, there may be many millions of records for services in one year that show up in a subsequent fiscal year of data. In this case, it is not services that are missing. The service date and provider are complete, but the total amount paid may be incomplete until the fiscal year payment data "catch up" to the fiscal year service data.
  • Claims for specific services can sometimes be split into more than one payment record. One example is retro-payments discussed above. In addition, multiple services may need to be combined to represent a single encounter. In most cases, we consider an ‘encounter' the unique combination of physician, patient and date of service.
  • The number of services paid by non fee-for-service methods, i.e. alternative payment plans, such as salaried, sessional, and service agreement contracts, has been increasing dramatically in recent years (CIHI 2008). The relative importance of these alternative payments varies by region (greater alternative payments schemes in rural and remote areas of the province) and by specialty of physician.

References

Fields Available

Field Name

Description

Birth Date**

 

Sex

 

Subsidy
Code

Indicates actual rate of premium subsidy, based on family income.

Date of
Service

The date the service was provided.

Practitioner Number

Identifies the health care practitioner who performed the service. [Replaced by a project-specific identification number.]

Specialty
Code

Describes a practitioner's specialty associated with a claim, assigned at the time when the claim was processed. Also includes several 'type of practice' codes in use for the Primary Care Demonstration Project.

Payee Number**

Indicates the practitioner, hospital, office, institution, etc. to which payment of a claim is made.[Replaced by a project-specific identification number.]

Referring Practitioner Number

Identifies the health practitioner who referred the patient to the performing health service provider. [Replaced by a project-specific identification number.]

Service
Code

Indicates the type of services rendered by a practitioner.

Service Units Paid

 A number indicating how many payments were made for a particular fee item.

Fee Item
Paid

A code used to identify each service provided by a practitioner. Each fee item has an associated "fee" that is paid to the payee for the service provided. >> more details

Amount Paid

Adjudicated amount paid to the practitioner for a fee item, cents included.

Date Paid

The date on which the claim was paid.

Payment Recipient Code

Indicates whether payment was made to practitioner or subscriber.

Service
Where Code

Indicates province (or out-of-country location) of practitioner providing the service.

Patient
Postal Code**

Patient's postal code (first included in 88/89).

Province of Patient
Code

Province or territory of residence of recipient of service (available from 88/89 onward).

 ICD9 Code

Contains the ICD9 code most closely associated with the billing record (available from 91/92 onward).

Service Location
Code

Indicates whether service was performed at a hospital etc. (available from 94/95 onward).

 Claim Type

Identifies the party responsible for paying the claim (MSP, ICBC, WCB) (available from 99/00 onward).

Several fields detail retroactive and rollback payments available from 1994/95 onwards. These are usually only necessary for projects involving these specific topics. Please contact Population Data BC for more information.

** Data field which could potentially identify an individual, and which therefore is only released to researchers having a clear need for the data in order to accomplish their research project.


Page last revised: November 1, 2017