Pre-payment assessment

Pre-payment assessment

If you have pre-payment assessment claims that have been rejected or adjusted by MSI, you may have the right to appeal.

Step 1: Review MSI billing statements carefully 

Rejected or adjusted claims will be noted as "GN080 MSI Result." Claim reviews must be requested within 10 business days. Be sure your billing staff are aware of and watching for this code.

Step 2: File a request for review

If MSI notifies you of a rejection of or an adjustment to a claim (pre-payment assessment result) that is not related to a policy or rules issue, you can file a Request for Re-payment Assessment Review within 10 business days of receiving the MSI result. If you do not initiate this request, it is assumed you agree with the pre-payment assessment.

Step 3: Medical consultants review physician request

Doctors Nova Scotia’s medical consultant, Dr. Ken Wilson, and Dr. Anne Tweed, the Department of Health and Wellness medical consultant, will review the request within 15 business days of receipt. If one or both determine the dispute is not policy related and does not indicate a pattern of non-compliance with the billing rules, the issue moves directly to facilitated resolution.

Step 4: Facilitated resolution

Facilitated resolution involves an informal meeting with you, MSI representatives, the medical consultants for DNS and the DHW, and a non-physician facilitator, who will work together resolve the issue. The goal of this meeting is to reach a resolution through conversation and education. Physicians are not permitted to have legal counsel at this meeting.

If you require assistance navigating the audit appeal process, contact DNS.

Contact

Jessica Moore
Compensation manager, Master Agreement and Fee Schedule
902-481-4922
1-800-563-3427 ext. 4922