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Provincial (Medicare) billing (PEI)
Billing for out-of-province referrals (PEI)
Billing for out-of-province referrals (PEI)
Updated over a week ago

If you need to refer a patient to an out-of-province specialist, you must send a request to Health PEI (HPEI) by creating and submitting a no-charge referral claim. The request is reviewed by HPEI and you and the patient receive a letter indicating whether the request is approved or denied.

When creating a claim, you must add the name and billing number of the provider you are referring the patient to.


1. Depending on your workflow, create an insured bill from an encounter, from the Visits dashboard or from the patient's chart.

2. Add the service codes 0113 (limited office visit) and 9401 (Service not available locally consult). See Adding and modifying billing items (service codes) to your provincial bills for more details.

3. Under Diagnosis Codes for each billing item, search for and select the diagnosis you're referring the patient for.

4. When entering the service code 9401, in the Edit PEI Billing Item window, the Referred To checkbox in the billing item is selected automatically.

5. Under Referred To, click the Search icon, and search for the referring practitioner by name specialty, facility, etc. The provider's Name and practitioner Number are added. Alternatively you can type the provider's Name and billing Number if they do not appear in the search.

๐Ÿ’ก Tip: If the provider you are searching for doesn't display in the search results, add them as a contact in the Contacts area of the CHR. You can then return to the bill and then search for and select them.

6. Click Save.

๐Ÿ“Œ Note: If you did not add the Referred To details, you cannot save the billing item. A validation error message appears.

Created: January 8, 2022

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