Acts and Regulations

84-20 - General

Section 15
Disposition versions

Full text
15(1)In this section and section 5.4 of the Act, “assess”, with respect to accounts submitted for payment under the medical services plan means
(a) to evaluate the accounts,
(b) to investigate the accounts to determine their correctness or validity, and
(c) to apply and interpret the agreement and the rules applicable to the assessment of accounts made under paragraph (3)(a) to the accounts submitted for payment,
and “assessment” has a corresponding meaning.
15(2)The provincial authority may, in the provincial authority’s sole discretion, require any person who has submitted an account for payment by the Medicare Branch to supply such additional information within such time as in the opinion of the provincial authority is necessary to enable an assessment to be made.
15(3)The provincial authority may
(a) develop, in consultation with the Professional Review Committee, rules applicable to the assessment of accounts, and
(b) in addition to those actions referred to in the Act, take such action with respect to the payment of accounts so assessed which, in the opinion of the provincial authority, will give effect to assessments made under the Act such as
(i) denying payment of an account,
(ii) providing that payment with respect to any entitled service for which payment is claimed in an account be made at a rate less than that provided in the agreement for the entitled service, or
(iii) any other action that the provincial authority considers necessary.
96-48; 96-111; 99-29; 2010-106
15(1)In this section and section 5.4 of the Act, “assess”, with respect to accounts submitted for payment under the medical services plan means
(a) to evaluate the accounts,
(b) to investigate the accounts to determine their correctness or validity, and
(c) to apply and interpret the agreement and the rules applicable to the assessment of accounts made under paragraph (3)(a) to the accounts submitted for payment,
and “assessment” has a corresponding meaning.
15(2)The provincial authority may, in the provincial authority’s sole discretion, require any person who has submitted an account for payment by the Medicare Branch to supply such additional information within such time as in the opinion of the provincial authority is necessary to enable an assessment to be made.
15(3)The provincial authority may
(a) develop, in consultation with the Professional Review Committee, rules applicable to the assessment of accounts, and
(b) in addition to those actions referred to in the Act, take such action with respect to the payment of accounts so assessed which, in the opinion of the provincial authority, will give effect to assessments made under the Act such as
(i) denying payment of an account,
(ii) providing that payment with respect to any entitled service for which payment is claimed in an account be made at a rate less than that provided in the agreement for the entitled service, or
(iii) any other action that the provincial authority considers necessary.
96-48; 96-111; 99-29; 2010-106
15(1)In this section and section 5.4 of the Act, “assess”, with respect to accounts submitted for payment under the medical services plan means
(a) to evaluate the accounts,
(b) to investigate the accounts to determine their correctness or validity, and
(c) to apply and interpret the agreement and the rules applicable to the assessment of accounts made under paragraph (3)(a) to the accounts submitted for payment,
and “assessment” has a corresponding meaning.
15(2)The provincial authority may, in the provincial authority’s sole discretion, require any person who has submitted an account for payment by the Medicare Branch to supply such additional information within such time as in the opinion of the provincial authority is necessary to enable an assessment to be made.
15(3)The provincial authority may
(a) develop, in consultation with the Medical Assessment Advisory Committee, rules applicable to the assessment of accounts, and
(b) in addition to those actions referred to in the Act, take such action with respect to the payment of accounts so assessed which, in the opinion of the provincial authority, will give effect to assessments made under the Act such as
(i) denying payment of an account,
(ii) providing that payment with respect to any entitled service for which payment is claimed in an account be made at a rate less than that provided in the agreement for the entitled service, or
(iii) any other action that the provincial authority considers necessary.
96-48; 96-111; 99-29