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Reciprocal billing for Out of Province patients in Alberta | The ClinicAid blog

Reciprocal billing can be one of the more confusing parts of medical billing in Canada. Because each province has its own health care system, agreements have to be made between provinces in order for physicians who see an out-of-province patient to still be paid for the services provided. An Interprovincial Reciprocal Payment Agreement has been established between all of the Canadian provinces and territories (except Quebec) in order to allow for reciprocal billing.

Reciprocal billing works to ensure that all eligible Canadian residents have access to insured health services, regardless of where in Canada they are seeking medical help. Alberta physicians are able to use ClinicAid to create any reciprocal billing claims, as long as some key information is filled out.

If the patient's province and healthcare type is filled out in their demographic record as a non-Alberta province, the bill will be automatically created as an out-of-province bill. The following patient details must also be completed in order for the bill to be processed correctly:
  • birth date
  • gender
  • full address
An out-of-province patient's bill in ClinicAid will automatically:
  1. put the out-of-province health card number into the "Registration Number" field in the Advanced tab. It will be removed from the "Health #" field, where it normally would show for an in-province patient.
  2. set the "Recovery Code" in the Advanced tab to the appropriate code that matches the out-of-province patient's province/territory.
  3. fill out the "Service Recipient" demographic section in the Demographics tab.
Once the bill is sent off to Alberta Health, it will be processed as your other bills are normally. If the bill comes back rejected, you'll be able to view the rejection reason at the top of the invoice and edit the bill as necessary.


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