Lesley Barron

The applicant physician appealed the General Manager's denial of five claims for surgical procedures.

The General Manager argued the claims were stale dated under s. 18(3) of the Health Insurance Act because the applicant failed to submit requested operating room notes within six months of the service date.

The Physician Payment Review Board found that the claims were submitted within the prescribed time and that the request for operating room notes constituted an interim assessment under s. 18(2), not a prescribed requirement under s. 18(3).

The Board ordered the applicant to resubmit the claims with the notes for a fresh assessment by the General Manager.