OHIP Health Card Validation

What is OHIP’s Health Card Validation Service? (HCV)

The Heath Card Validation service is a free healthcare validation system provided by the Ministry of Health and Long-Term Care (MOHLTC) that allows doctors and healthcare organizations to automatically check if a patient’s health card number is valid.

This allows you to verify if your patient is currently covered under OHIP and eligible for health care.

How can I sign up?

You are automatically enrolled in HCV when you receive your OHIP Billing number.
The Ministry of Health will send you a letter that outlines instructions for setting up GO Secure, and MC EDT Registration. Within that letter you will also be given a unique PIN (Personal Identification Number) for HCV.

If for some reason 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.

How to Access HCV

Although this is a free service and the ministry doesn’t charge for Health Card Validation access, they don’t have their own applications or software. In order to check directly through them you need to call a toll-free 1-800 number and use your PIN each time you see a patient. (Sounds time consuming right)?

Luckily, they do allow 3rd party organizations to check eligibility in real time against their records/database.

Therefore, you currently have 3 options to check health card validation in real time

1.     Interactive Voice Response (IVR)

2.     Health Card Validation (HCV) Web Service,

3.     Health Card Reader Software Application

Interactive Voice Response (IVR)

This is the system mentioned above that can only be done directly through the Ministry of Health. In order to validate your patient’s health card number, you need to call the ministry’s toll-free line from a touch tone telephone (meaning it won’t work from your cell phone), and use your PIN in order to get access.
The number is 1 800 262-6524.

This is obviously not very realistic in a busy work environment, which is why the ministry themselves strongly recommend using IVR as a backup method in case other software applications are unavailable.

Health Card Validation (HCV) Web Service

The HCV Web Service is the most secure service to validate the eligibility of a patient’s health card in real-time, as it’s an internet-enabled service that can be accessed from a provider’s connection directly to the ministry. This type of Health card validation is usually integrated within a patient registration system.

Health Card Reader Software Application

This is usually a small machine used to swipe the health card, similar to a credit card, to see if it’s valid. The machine is connected to your computer and your patient’s eligibility will appear on the screen.

The Validation Process

Health Card Validation (HCV.jpg

When a health card’s magnetic card is swiped, or the health number is typed in, this information is instantly checked against OHIP’s records and verified.

The validation process consists of edit checks to determine if the:

    • Health number is valid;

    • 10-digit health number has been issued by the ministry;

    • Health number presented belongs to an insured person who is eligible for health care in the province of Ontario; and

    • Health card is current (by checking the version code).

If the patient doesn’t have coverage, then a response will indicate what the reason is and why the card has been rejected.

Is it Necessary?

While HCV isn’t necessary, being able to check if your patient is eligible for OHIP services will reduce the amount of rejections and errors you get.

Here are some of the best advantages of using any HCV service: 

  • Verify patient data;

  • Reduce eligibility claim rejections by ensuring a client is eligible for service prior to service delivery;

  • Reduce version code claim rejections associated with incorrect version codes;

  • Reduce administrative costs by confirming uninsured clients to allow your billing team to direct bill clients (e.g. debit/credit, credit card/private invoice).

  • Reduce health care fraud

In our experience, most rejections are a direct result of the patient not having
valid insurance, so we strongly suggest a HCV service to validate your patient’s health card.

Using Health Card Validity on Your Phone

Billing on your iPhone takes away a lot of the hassle of paperwork and admin tasks. If you’re using Dr. Bill, we run an eligibility check on each patient you add. If they're not insured we let you know with an Alert.

You can fix the issue by updating the patient's information, adding the patient's ‘Out of Province’ care card information or by including their contact information and authorizing us to bill them privately.

If your claim is still rejected our billing agents will follow up for you, confirm the patient’s health number (or update to the latest version code) and resubmit.

Autofill for Manual Patient Entry

We’ve even taken this a step further. When you enter a valid Health Card Number and version code, the rest of a patient's demographic information will be automatically filled out. 

This can help save you time when creating new patients on our web app.

OHIP Health Card Validation

Our OHIP billing software makes capturing this information easy, fast and pain-free. We can handle rejections and help physicians bill correctly, so they can focus on what they do best: practicing medicine.

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.