The Ultimate OHIP Billing Guide

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New to Ontario Billing? Don’t know where to start? You’ve come to the right place! Our OHIP Billing Guide outlines every aspect of billing in Ontario, from registration and how to get started, to maximizing billings. And while billing can be stressful, confusing and time-consuming, rest assured it doesn’t have to be.  

Whether you’re new to mobile billing, or billing altogether, this guide will teach you how to start submitting claims to OHIP. Why learn from us? We’ve built the best software-based medical billing solution in Canada, which has allowed doctors to earn more, while freeing up their time. We not only help doctors solve their billing problems - we prevent them.


In order to help you get started and generally just feel more confident when submitting claims, we’ve compiled all of our expertise into this ultimate OHIP billing guide. Each chapter is outlined below so you can click on whatever interests you the most and start mastering billing today.


Chapter 1: Medical Billing in Ontario

  • Everything you need to know about how Medical Billing works in Ontario.

Chapter 2: Registration

  • If you’re new to OHIP billing, this section will explain how to get set up.

Chapter 3: Getting Started

  • If you decide to use Dr.Bill for your OHIP billing, here is all you need to know.

Chapter 4: Maximize Your Billing

  • Learn how to get the most out of your billing in both earnings and efficiency of time.

Chapter 5: Bonus Billing Resources

  • Have a billing code that you need to find? Perhaps you want an Ontario Schedule of Benefits PDF, check the submission deadlines or just learn more about how to bill better for your Speciality. This section has you covered.




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Chapter 1: Medical Billing in Ontario

  • Payment Models

  • Fee-For-Service

  • OHIP Schedule of Benefits

  • How are Claims Submitted? (MC EDT system)

  • Payment (OHIP Cut-Off Dates)


Payment Models

There are a variety of different ways that Canadian physicians get paid and it all really depends on where you practice and
and what the payment model is used there. In total, there are 3 options for Canadian doctors:

Alternative Payment Plans (APP)

Increasingly popular are the various alternative payment plan (APP) models. They may also be referred to as “alternative funding plans” or “new payment models”.

While they vary widely, APPs are generally made up of a combination of:

  • Fees for clinical services

  • Time-based payments

  • Rewards for participation in specific clinical initiatives

  • Population or capitation funding

  • Payment for admin costs

  • Bonuses for achieving specific targets

Salary

If you receive a regular salary, then this is usually paid in 'time-based payments'. These can vary from simple annual salaries to shift stipends, sessional payments or hourly rates. Doctors at an academic institution, community health centres or hospitals usually work under this model.

Fee-For-Service

About 70% of doctors in Canada work under a fee-for-service (FFS) model. In a traditional fee-for-service model, a doctor is essentially a small business.

So, how does it work? Basically, you must submit 'invoices' of who you saw and what you did to the Ministry of Health, who then reimburses you for the health care services you’ve provided. This is all done through the Ontario Health Insurance Plan (OHIP). The general process is:

  • You see a patient

  • You fill out a claim using a special code that explains what service you provided

  • You submit that claim to OHIP for payment

  • OHIP reviews the claim and reimburses you if they approve it

Each service has a code that corresponds to a specific dollar amount. For example, if you’re a GP and you see a patient for a visit you can submit a claim with the fee code A005 (Consultation). This fee code has a value of $77.20, which is how much OHIP would reimburse you for.

OHIP Schedule of Benefits

The OHIP schedule of benefits was created by the Ontario Ministry of Heath and outlines each fee code for each speciality, along with its rules and when you can use it.

Sounds easy enough right? The difficult part though, is that the Schedule of Benefits is actually a PDF that is nearly 750 pages long, with more than 6,000 codes. While we have to admit that it’s extremely detailed, it really makes trying to search through it, and understand if you’re actually eligible, a very tedious job.

The good news then? With the help of OHIP billing experts we’ve made things a whole lot easier by creating a searchable database of all OHIP diagnostic codes. You can search by speciality, code or keyword.


How are Claims Submitted?


After you choose your fee code, you’ll have to actually submit a claim in order to get paid. OHIP Claims get submitted through an electronic data system. This is done through the medical claims electronic data transfer (MC EDT) system.

The MC EDT system is a secure web service that allows third-party software providers to submit claims to OHIP on your behalf.

It allows:

• Secure user authentication;
• Designation to admin staff or third parties agents to submit and reconcile claims on your behalf;
• Electronic reports (Claims Error Reports, Remittance Advice Reports, etc).

It is the only system used to transfers claims to the Ontario Health ministry. In order to use it, you need to be an authorized MC EDT use (you can find the exact instructions for setting up your MC EDT account in Chapter 2 but if you can’t wait follow these steps.

Important Takeaway:

To be reimbursed through OHIP for any healthcare services provided, a claim has to be submitted through the MC EDT system with the appropriate "Fee Code" along with the patient's information, there is no way around this and this is the process for any fee-for-service payment model.


Payment - OHIP Cut-Off Dates

OHIP claim submissions run on a monthly cycle, and are based around the 18th of each month. The 18th is the deadline, also known as the “cut-off date,” which means that any claims you submit up until the 18th of each month will be processed for payment by the 15th of the next month. When the 18th falls on a weekend or holiday, OHIP moves the cut-off date to the next business day.

Sometimes, claims received after the 18th of the month might still get processed by the end of the month, but to make you get paid on time we suggest submitting before 5pm on the 18th.

The best way you can remember the deadlines for MC EDT claim submissions is to download a shareable calendar of the OHIP Cut-Off Dates 2018/2019





Chapter 2: Registration

  • Register for an OHIP Number

  • Sign Up for an OHIP Billing Service

  • Set Up Your “Go Secure” Account

  • Register for MC EDT

  • Designation

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Before you can bill anything there are several steps you’ll need to do in order to get started with OHIP Billing. Each step is outlined below, in the exact order you’ll need to do them. We should warn you though, at first glance the registration process can seem a bit daunting, but don’t worry, after the first step all of it can be done online and is actually pretty quick.

Register for an OHIP Number

The first step is to register with OHIP in order to get an OHIP billing number. This step is absolutely necessary because you cannot submit claims for reimbursement without it. Getting the actual OHIP number typically takes anywhere from 4-6 weeks, so make sure this is the first thing you do, and make sure you do it as soon as possible.


Registration Steps

1. Complete and sign the Application for OHIP Billing Number for Health Professionals form

2. Attach a copy of a blank cheque with "VOID" written on it (in order to set up direct deposit)

3. Attach a copy of a valid Certificate of Registration with a governing body

There are three ways to submit your application, by email, fax or snail mail.

When your application is processed you’ll receive a letter from the Ministry of Health that contains your OHIP billing number and two  'unique identifiers.’ (which you will need for the next steps: registering for GO Secure, and Medical Claims Electronic Data Transfer - MC EDT).  

If you don't receive this letter or you already have a valid OHIP billing number, contact the Ministry of Health by phone (1-800 262-6524) to have one re-issued.


Sign Up for an OHIP Billing Service

In order to submit claims you’ll need a billing service or software system who can submit them for you. There are many benefits of billing with Dr. Bill, and you’ll have billing support so you can learn as you go. If you’d like to sign up for Dr. Bill and bill from your mobile phone, you can sign up on the web here, or download the app on iOS and sign up through there.  



Set up Your “GO Secure” Account

Once you have your letter from OHIP and you’ve selected a billing service, you’ll be ready to set up your GO Secure account. You will need to have a GO Secure account in order to bill in Ontario. It is the secure system Ontario uses to access Ontario Public Services online and it’s where you will have access to the Medical Claims Electronic Data Transfer (MC EDT) system that allows you to share data with the Ministry. You cannot bill in Ontario with setting up this account.

Follow these 4 quick steps to set up your GO Secure account or click here for exact screenshots of how to register for both your Go Secure Account and MC EDT.

Once it’s set up you’ll get a confirmation by email – just click on the link given and sign in with your ID and password you previously created.



Register for a MC EDT Account

Now that you have both your OHIP billing number and your GO Secure account set-up you can register for your MC EDT Account. Follow the instructions below or check out our exact screenshots to see how to set up your Go Secure and MC EDT account together.

1. Go to the GO Secure login page (there's also a link you can follow included in your letter from the ministry of health).

2. Sign in with your GO Secure ID and password and type in your unique identifiers (included in your letter).

3. Confirm enrolment for MC EDT by selecting the indicated link to go to the GO Secure Login screen again.

4. Sign in with your GO Secure ID and password to go to the Administration and MOHLTC Services page.


Final Step: Designation

If you’re planning on using Dr. Bill for your claim submissions, then the final step is to add us as a designee (if you’re using another billing system the steps will be the same). This gives us permission to submit claims for you. This is a two-part process.

Part 1: Add Dr. Bill as a Designee on your Go Secure Account

Part 2: Authorize Dr. Bill to submit claims on your behalf


The process is further explained here, with detailed step by step instructions.


Chapter 3: Getting Started

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  • How does it Work

  • How to Add a Patient

  • Ontario Health Card Version Code (Eligibility)   

  • How to Add a Claim/LabelSnap

  • Understanding a Claim Status

  • Creating a List of Favourites

  • Default Account Settings

  • Multiple Specialities

  • Rejection Management

  • Submission Errors

  • Understanding a Claim Error


How Does it Work

You’re registered and ready to bill, now what? At Dr. Bill we submit the claims you create on our app to OHIP. They will pay you directly and we will charge our percentage to your credit card after your free trial has expired. If you’re not using Dr. Bill, feel free to skip the entire “Getting Started” section.


Benefits of Dr. Bill

As a software company, we’re able to make unique changes to our system that really meet the needs of our users. We’re constantly doing surveys and requesting feedback so that our software is up to date and innovating.

Mobile billing
has never been easier with access to our Label Snap (a feature on our mobile apps that lets you capture patient data instantly using your phone's camera). Plus, you’ll get amazing support from our expert billing agents. We are not just an app but a service too. Our billing agents handle rejections and help you with any billing question you might have.


Dr. Bill Plans

There are 3 different plans you can choose from, all depending on what you’re looking for. Each plan comes with free credit which acts as your free trial.


The Starter Plan - This is the best plan for physicians with a low number of monthly claims, who do not need any assistance.

The Full Serve Plan - This is the best plan for physicians who don't have time to manage rejections as our billing team will take care of this for you.

The Premium Plan - This is the best plan for physicians who are new to billing or have a complex practice. This is the only plan that offers phone support.


Privacy & Security

We’ve worked hard to build a software infrastructure that is secure and reliable. Our internal procedures and systems make sure that your patient's data is securely protected.

Your data is stored only on Canadian servers. This is the recommended approach by the CMA and we made sure to comply with all the relevant privacy legislation rules. For more information check out our privacy and security policy here.


How to Add a Patient/LabelSnap

In order to add a claim, you must first add a patient. There are several ways you can do this. You can manually add a patient by clicking on “new patient” and then filling in the necessary requirements or you can take a LabelSnap. A LabelSnap lets you capture patient data instantly using your phone's camera.

The LabelSnap feature can also be used to codify health cards.


Ontario Health Card Version Code (Eligibility)

In Ontario, the Ministry of Health and Long-Term Care offers a Health Card Validation (HCV) service that lets you check patient eligibility, so you can make sure a patient is valid before submitting a claim (therefore avoiding a rejection).

When you add at a patient, Dr. Bill will automatically fill out the patient's demographic information and check for eligibility. For more information on OHIP Health card Validation click here.


How to Add a Claim

From a patient's card, tap the 'New Claim' button to create a new claim. When selecting a Billing Item, you can search by number or description and tap the appropriate billing code. When you hit Diagnosis, you can search ICD9s and select up to three diagnoses. Then hit ‘save’ and you’re done!

You can also add a claim through the web app.

In Ontario, you can add multiple claims and multiple fee codes including your special visit codes and they'll be grouped together as a single encounter. Follow this tutorial to learn how.


*** If you’re using our iOS app, you can create a patient within a claim. Click on the video below to see how.


Understanding a Claim Status

Each claim gets a status. If you click on a claim and look under ‘status’ it will say submitted, submission error, rejected or pending. Click here for a description of each status.

Remember, if you’re on the full-serve or premium plan any time you revise a claim it will be automatically submitted for you with the new information.

Default Account Settings

If you're billing using the same service location or facility number, you can set a default in your Account Settings so you don't need to enter this on your claims every time.


Default Diagnosis

You can also add a default diagnosis to your claims by editing your account settings. This will help make the billing process that much faster.


Multiple Specialities

You can add multiple specialties to your profile, so you can easily change your specialty when creating claims. In order to do this, you’ll need to set it up under your account settings, watch this quick tutorial to find out how.


Creating a List of Favourites

With Dr. Bill you have the option of "starring" your most commonly used billing items, diagnostic codes, or referring physicians. Using this feature will populate your starred items at the top of your lists for easy searching.


Rejection Management

If you are on our Full-Serve or Premium plans, we will automatically correct and resubmit any rejected billings, so there’s not a lot to worry about! If we require any further information from you, we’ll notify you and request that information.

Remember, at any time that you revise a claim it will be automatically submitted for you with the new information.

Please remember, our Self-Serve plan does not include any claim management. This means that we will not see or handle your rejected claims; however we do have an option if you want agent support with a specific claim.


Understanding a Claim Error

Billing OHIP can result in having claims sent back with Claim Error Reports detailing various issues with submitted claims. Use our OHIP Error Code Search Tool to look up any error codes you may see on your reports.


Submission Errors

Submission errors are claims that have not passed the pre-edit approval process by OHIP. Typically, these are patient insurance issues or referring physician issues.


If you log in at app.dr-bill.ca you will see ‘Billing Issues’ on the top right. You can then see the breakdown of your refusals there. If you’re on a plan that includes rejection management, there may be messages under your ‘Billing Issues.’ These are things that we have sent to you and require your input. Anything else we handle for you.


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Chapter 4: Maximize Your Billing

  • Understanding Premiums & Other Tips

  • Telephone Consultations

  • Best Practices

  • How to Earn More & Save Time



The number one reason why physicians get burned out is due to paperwork. A typical doctor will spend a few hours each week on paperwork, on top of their already full schedule. This is why Dr. Bill was created, it automates billing tasks that are repetitive and time-consuming. There are numerous benefits of medical software billing and getting a return on investment has never been easier. Being able to actively control and manage your income is a great way to maximize and track your earnings. This chapter will help you understand some simple things you can do to really maximize your earning potential.


Understanding Premiums

It’s a good idea to understand and utilize premiums. Remember, you want to get paid properly for your services and premiums are a great way to maximize certain fee codes. If you’re billing with Dr. Bill when you enter a billing code we automatically display certain premiums that may apply.


You can also check out our quick guidelines to using “OHIP Premiums.” Just remember, premiums need an “A prefix” and a visit fee. (C prefix codes are for non-urgent Inpatient visits and therefore no special visits apply). Be sure to use premiums that MATCH the SLI (service location indicator) on the claim.

If you’re providing anaesthesia services, it’s worth taking a look at this article that outlines specific billing tips for anesthesia age premiums.


Additionally, you can also check our “OHIP searchable database,” using the keyword “premium.”


Telephone Consultations

Take Advantage of Telephone and Email Follow-ups. These can add up quickly and can be quite lucrative, especially since follow ups are already a part of the job.

For example, any clinical discussion that takes place about a specific patient, is billable. You can check out this quick guide to telephone consultations, comprehensive consults and detention, as well as this outline for Telehealth codes (health services provided by a physician over live video instead of in-person).


Best Practices

In order to maximize billing there are a few tips we suggest every physician follows. This section is about best practices and what will be most effective for your business in the long run.

Submit Claims within 6 Months

Submitting your claims to OHIP on time is very important to ensure you get paid for the services you provide. OHIP pays six months to date of service but only accepts RAI’s (Remittance Advice Inquiry) within 3 months.


Bill Daily

The best thing you can do is to treat billing as if it were part of patient care. This will be very beneficial because the information will be fresh in your mind and you’ll also get into the habit of never forgetting to bill. Prioritize your time for billing and don’t let it pile up.

Earn More & Save Time

In addition to best practices, there are two key things you can do to earn more money and save more time.


i.Best Plans (Rejection Management)

We’ve already mentioned rejection management once, but it’s worth bringing up again because if you don’t have a good system this is sure to result in lost revenue. In general, Dr. Bill has recovered between 86% - 96% of rejections. We’ve been able to do this almost entirely through our rejection management, in which we review each claim within 30 days of remittance.

If you are on our Full-Serve or Premium plan we will correct and resubmit any rejected billings for you. Our software automatically picks up most refused claims and resubmits them. If we need more information, we will notify you. This has not only saved our doctors time, but has led to recovered funds for 10,500 claims that might have otherwise gone unnoticed or sat as refused.

Pro Tip: We’ve noticed that most rejected claims we’ve been able to recover have been a direct result of either not adding a referring physician OR not double checking that your patient has insurance. Make sure you always check these two things before submitting a claim.



ii. Mobile Billing + Experts

Why should you switch to mobile billing today? You can automate submissions and have shortcuts to let you bill faster. Systems like ours are built on a database of Ontario billing codes, making it easy to look up and apply the correct one. This saves you time and reduces the likelihood of a claim getting rejected. The majority of our users’ report saving at least 5-10 hours a month. Instead of spending weeknights and weekends finishing paperwork, doctors can bill claims in 30 seconds using their smartphone. It's as simple as taking a picture.

Besides just billing on your mobile, it’s extremely important to make sure you have access to billing experts. Billing is a learnt skill and something that isn’t taught in Med school. Billing yourself allows you to be in control of your income and make sure you’re billing for everything you do, but having access to a billing expert will reduce your rejection rate, helping you save time and money.


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Chapter 5: Bonus Billing Resources

  • OHIP Fee Codes

  • Important Dates

  • Printable PDFs

  • OHIP Help Centre


Congratulations, you’ve made it to the end! Whether you’ve skipped over some parts or re-read others, we hope you’re getting the hang of it. Billing can seem overwhelming but when you have support and automated services it’s more just about getting started. Below you’ll find a list of billing resources that we know you’ll find useful, save them to your desktop or mobile phone and refer to them whenever you need to.

OHIP Fee Codes
Here is a list of important fee codes and searchable databases that you can use to easily reference/find the right OHIP code.


Important Dates

Here is a list of important dates. Save links to them, write them down and don’t forget!


Printable PDFs

If you prefer to print or save a copy to your desktop, check out these printable versions:


Help Centre Articles   

Check our help centre for more questions on how to navigate billing through Dr. Bill. There are over 20 useful articles with detailed screenshots/videos.


If at any time you’d like to speak to one of our expert OHIP billing agents just contact us here.