Whether you’re a new grad or simply new to the province, billing for the services you provide can seem like a confusing process. We’re here to help – follow the steps below to get started.
Registration
- Get a billing number by registering with the Ministry of Health
- Register for a GO Secure Account
- Register for Medical Claims Electronic Data Transmission (MCEDT)
Knowledge
Important: learn the OHIP billing codes for your specialty. Knowing when and how to use each code is vital to ensuring that you get paid correctly for your services.
This will also help reduce the number of rejections, reviews and resubmissions that can happen when billing OHIP. See the list of OHIP error codes and learn about common rejection issues.
Be aware of cut-off dates for claim submissions.
OHIP claim submissions run on a monthly cycle. All claims you submit until the 18th of each month will be processed for payment by the 15th of the next month.
It’s recommended that you submit your claims daily so that you never have an issue with deadlines. See the list of OHIP cut-off dates.
Process
Decide on a system for keeping your claims in order.
The Canadian Medical Association reports that that the average physician fails to bill for at least 5% of the insured services they provide.
By missing claims you’ll be leaving money on the table, so they recommend using a smartphone or tablet app that captures the services that you deliver.
Determine how you’re going to manage submitting claims to OHIP.
Will these be handled by your hospital / group, a 3rd-party billing agent or will you be managing your own billing?
Set yourself up for success now to avoid headaches down the road, which will help ensure that you get paid correctly (and on time).
Free OHIP Billing Resources
General Tips & FAQs
- The deadline for submissions is the 18th of each month (or the next business day if it falls on a weekend/holiday)
- Claims received after the submission deadline may still be processed for the current cycle
- Providers must submit claims within 6 months of the date of service (claims submitted after 6 months will be rejected)
- The majority of billings are first assessed through a computer system – around 20% get sent to Claims Assessors to be manually checked
- Claims that go into manual review may need extra documentation to get paid
- Paid claims will be shown on your Remittance Advice (RA) report
- Rejected claims will appear on the Claims Error report or the RA report with an explanatory code. You must resubmit these claims
Want to learn more?
Check out our knowledge base, where we’re continually adding articles about OHIP billing.
Want to maximize your earnings? New to Ontario Billing? Check out our Ultimate OHIP Billing Guide that takes you through every step for billing successfully in Ontario.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
