Form HLTH5430 "Medical Services Plan (Msp) Payment Information Checklist" - British Columbia, Canada

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Download Form HLTH5430 "Medical Services Plan (Msp) Payment Information Checklist" - British Columbia, Canada

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MEDICAL SERVICES PLAN (MSP)
PAYMENT INFORMATION CHECKLIST
MINISTRY OF HEALTH USE ONLY
File Number
Date Received
Submit this completed form to the email address:
HealthDataHA@gov.bc.ca
ISP Appendix
Questions about the request process or any part of this application
may be directed to the email address above.
PROJECT TITLE
APPLIES TO COHORT(S)
DATE RANGE
From (yyyy/mm/dd)
To (yyyy/mm/dd)
OTHER DATE RANGE AND FILTERING CRITERIA
MEDICAL SERVICES PLAN PAYMENT INFORMATION (January 1, 1990 onwards)
The data includes MSP insured medical fee-for-service and alternate payment services provided by general practitioners and specialists. It also
includes MSP insured services provided by other health practitioners such as chiropractors, naturopaths, physical therapy, oral surgeons, podiatrists,
optometrists, dental surgeons, oral medicine, orthodontists, massage practitioners, acupuncturists and midwives.
These data do NOT include therapeutic abortion data in accordance with the BC Freedom of Information and Protection of Privacy Act.
The data dictionary for the MSP variables in this checklist is available at:
www.gov.bc.ca/health/forms/5430datadictionary.pdf
Normally only medical fee-for-service and alternate payment (encounter) services provided by medical practitioners are included in the extract.
Please check the box if you require services by other health practitioners.
Please provide a rationale if you require services by other health practitioners.
HLTH 5430 2015/12/07 PAGE 1 OF 3
MEDICAL SERVICES PLAN (MSP)
PAYMENT INFORMATION CHECKLIST
MINISTRY OF HEALTH USE ONLY
File Number
Date Received
Submit this completed form to the email address:
HealthDataHA@gov.bc.ca
ISP Appendix
Questions about the request process or any part of this application
may be directed to the email address above.
PROJECT TITLE
APPLIES TO COHORT(S)
DATE RANGE
From (yyyy/mm/dd)
To (yyyy/mm/dd)
OTHER DATE RANGE AND FILTERING CRITERIA
MEDICAL SERVICES PLAN PAYMENT INFORMATION (January 1, 1990 onwards)
The data includes MSP insured medical fee-for-service and alternate payment services provided by general practitioners and specialists. It also
includes MSP insured services provided by other health practitioners such as chiropractors, naturopaths, physical therapy, oral surgeons, podiatrists,
optometrists, dental surgeons, oral medicine, orthodontists, massage practitioners, acupuncturists and midwives.
These data do NOT include therapeutic abortion data in accordance with the BC Freedom of Information and Protection of Privacy Act.
The data dictionary for the MSP variables in this checklist is available at:
www.gov.bc.ca/health/forms/5430datadictionary.pdf
Normally only medical fee-for-service and alternate payment (encounter) services provided by medical practitioners are included in the extract.
Please check the box if you require services by other health practitioners.
Please provide a rationale if you require services by other health practitioners.
HLTH 5430 2015/12/07 PAGE 1 OF 3
VARIABLE
DATA VARIABLES
REASON FOR REQUEST
NAMES
Personal Health Number (Replaced by
PHNNUM
project-specific Patient Study
Identification number)
CLNTGNDR
Client Gender
CLNTAGRP
Client Age Group
CLNTHA
Client HA
CLNTHSDA
Client HSDA
CLNTLHA
Client LHA
FSA
Client FSA
SERVDT
Service date
FITM
Fee Item
SERVCD
Service code
DIAGCD
ICD9 diagnostic code
PAIDSERV
Paid service
EXPEND
Expenditure
ENCTRSERV
Encounter Claim service
Payee number (Replaced by
PAYENUM
project-specific identification number)
CLMTP
Claim type
PRACNUM
Practitioner number (Replaced by
project-specific identification number)
CLMSPEC
Claim specialty
Referring practitioner number (Replaced by
PRACRFBY
project-specific identification number)
CLNTPROV
Client Province
HLTH 5430 2015/12/07 PAGE 2 OF 3
VARIABLE
DATA VARIABLES
REASON FOR REQUEST
NAMES
SERVPLC
Service place
SERVLOC
Service location
Please provide a detailed list of variables, description and rationale in a separate document
Additional MSP variables
(blank checklist available). The Ministry will assess the availability upon request.
HLTH 5430 2015/12/07 PAGE 3 OF 3
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