mediclaim.ca

Enter your data correctly. If you enter the wrong MSP and Payee numbers - your claims will be refused.

Your Email Address:
*Required
Subject/Your Physician Information:

MSP Number:

ie the number you give to pharmacies - commonly referred to as your billing number.
*Required

Doctor Last Name:
*Required
Doctor First Name:
*Required
Doctor Middle Name ( or initial):

Payee Number:

ie the number that MSP gives to to get paid. This may change if you are incorporated!
*Required

Address:
*Required
City:
*Required
Postal Code:
*Required
Home Phone:
*Required
Work Phone:
*Required
Cellphone:

Pager:

Nature of Practice: