In order to bill the Ontario Health Insurance Plan ("OHIP") for a consultation, the following criteria must be met:
The patient must have a valid OHIP health card number (HCN).
The consultation must be completed via audio or video (text-based consultations are not eligible).
Both the patient and provider must be physically located in Ontario at the time of the visit.
For full details, refer to Bulletin 221203 — Virtual Health Care in Ontario here.
Additionally, each consultation must include a billing and diagnostic code.
You are responsible for adding these codes to the consultation — see Adding a billing code to a consultation for step-by-step instructions.
Maple will top up the OHIP payment based on the billing code entered and the time of the consultation.
Note on non-OHIP (uninsured) services
If you are providing both OHIP insured and non-OHIP (uninsured) services to a patient (e.g., completing an assessment and providing a sick note), you can bill OHIP as usual for the insured assessment.
If you only provide a non-OHIP insured service, use the 999 code to indicate the consult is uninsured.
The payment amount varies based on when the consultation occurs:
Weekday: 7:00 AM – 11:59 PM
Overnight: 12:00 AM – 6:59 AM
Weekend/Holiday: All day
This table outlines the use of billing codes and the payment details:
Please only verify a patient's health card in our system once you have seen a copy and can confirm the name, number, and expiry date match the patient's profile.
If a patient did not have a verified health card at the time of the consultation, only the 999 Visits Not OHIP compliant billing code option will be available.
Note: Non-subscribers with a valid OHIP HCN must have an external medical professional complete a patient intake form before they can request a consultation.