OHIP billing claims will begin processing automatically as soon as the provider enters a billing code. The “Billing and diagnostic codes” tab of each OHIP consultation summary will now include a status:
Submitted for processing - you’ve added the billing and diagnostic codes, and the claim is being processed by the MoH
Paid - the claim has been approved by the MoH, and will be added to your invoice
Rejected - the claim must be updated and resubmitted to the MoH. A reason for rejection will be displayed
Settled - no further action will be taken on this claim
Rejected claims
Rejected claims will appear in your “Earnings / Reports tab” under the new “Rejected billing codes” subheading, with the status indicating the reason for rejections.
Rejections will be divided into two categories:
Rejections that must be resolved by the provider
Rejections that can be resolved by the Maple team
Rejections that must be resolved by the provider
You will be notified by email when a claim must be resolved by the provider, such as for claims with an invalid diagnostic code. These can be resolved from the “Earnings / Reports tab.” Clicking the “View” link will bring you to the consult summary page, where you can fix any issues with the claim that has been rejected. By saving the claim, it resubmits for processing.
Rejections that can be resolved by Maple
Claims that can be resolved by the Maple team, such as issues with the patient’s health number, will be resolved and resubmitted by us on your behalf. The error messages that will be resolved by Maple without any action on your part are as follows:
Version Code Does not Match Date of Service - Check Version Code
Health Number is Invalid - Call 1-888-360-7530 with your PIN to access Health Card information
Invalid version code - Call 1-888-360-7530 with your PIN to access Health Card information
Service has been rendered by another Practitioner - Change FSC and resubmit: to dispute, ask other practioner to retract claim or provide documentation to support your claim
Service excluded from RMB coverage. To bill patient directly, change the Insurance Provider to 'Third Party - Private billing' and include billing address in label photo or Ministry Review details
Importantly, this update means that OHIP consultations will only be added to your invoice once the claim has been successfully paid out by the Ministry of Health. Please note that rejections must be resolved within three months of the service date in order to be paid out.