Contract Payee Reservation Request

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Contract Payee Reservation Request

This form is for contract managers at health authorities and other agencies delivering health services to reserve a Y-status payee for a contracted clinical program. Y-status payees are used to provide encounter reporting to Teleplan or to recover MSP payments to service contract budgets. Requests will be reviewed by staff in the Alternative Payments Program and forwarded to Health Insurance BC to be reserved if it is determined that it is for a net-new contracted program that does not already have payee reserved for it. This form should not be used to request payees for fee-for-service practices and requests of this nature will not be processed.
Missing or incorrect value
Missing or incorrect valuee.g. Primary Care; Laboratory Medicine; Surgical Services; etc.
Missing or incorrect valueIf region-wide, please put “Region-Wide”
Missing or incorrect valueIf region-wide, address of office where service is coordinated.
Missing or incorrect value
Missing or incorrect value
Missing or incorrect value
Missing or incorrect value
555-555-5555 Missing or incorrect value
Missing or incorrect valueName of the clinical program. If related to an existing program, please provide the same name already as used in SCRUBS
Is this service health authority wide?
Payee Start Date Missing or incorrect valueShould align with the start of a contract

Keep a Copy for Your Records (optional)

If you want to keep a copy for your records, you can download a copy using the PDF button below.

Submit Your Form

Use the submit button to send this form to Compensation Policy and Programs, Ministry of Health.
HLTH 8106   2021/11/23
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