Here, we'll go over everything you need to submit OHIP claims to the Ministry of Health (MOH), confirm thos claim files were received, correct any claim errors, and, finally, reconciling your outstanding invoices with your monthly remittance advice (RA).
Let's cover the Administration>Billing menu items below;
- Simulation OHIP File
- Generating OHIP File
- MCEDT Mailbox
- View MOH Files
- Billing Correction
- Billing Reconciliation
💡 Before creating an OHIP billing claim file for submission, you need individual OHIP invoices ready to submit. Click Here to see how to create an OHIP billing claim.💡
1. Simulation OHIP File
When you have a billing claims ready to submit to OHIP, it's best to run an OHIP file simulation first. This allows you to check for health card and/or fee code errors and correct them before submitting them to the MOH.
Under ‘Simulation OHIP File’ select the providers and date range you'd like to simulate then select ‘Create Report’.
💡 Any errors will be flagged and appear in the comment section of the billing claims. ‘H’ indicates that there is either an error in the health card information or the patient is from out of province.💡
Once all of the errors in the simulation have been resolved, the billing claims are ready to be generated into a live OHIP billing claim file to send to the MOH.
2. Generating OHIP File
Once the simulation has been run and errors corrected go to ‘Generate OHIP File’ and select the providers and date range you would like to create a billing claim file for then select ‘Create Report’.
💡 Leaving the ‘Service Date Start’ blank will simply select any unsubmitted claims from before the ‘Service Date End’ date.💡
Once created, the claim file is ready to be sent to the MOH through the MCEDT Mailbox.
3. MCEDT Mailbox
All claim files that are pending to send will appear in the ‘Upload’ folder of the MCEDT Mailbox. Select the claim files you would like to send and click ‘SUBMIT’.
Once sent, you should received a success message indicating the files have uploaded to MCEDT. After 48-72 hours, the claim file will have been reviewed be the MOH and should see two items in your MCEDT Download Mailbox:
1) Batch Edit - confirming receipt of your Claim file
2) Error Report - if the claim file contained any errors needing correction
1) Batch Edit
This report confirms the claim file was successfully received by the MOH. To check its contents, download the batch edit in the MCEDT Mailbox by selecting ‘Download’ in the mailbox → selecting the batch edit file → then scrolling to the bottom of the display to select ‘Download’.
The claim file will now be able to be viewed under ‘View MOH Files’. Opening it will show the details of the batch edit report and most importantly the ‘Rejection Reason’. If there is no error code indicated under it, then the claim file reached the MOH without issue.
2) Error Reports
These reports inform you of any errors in the claim file submission. The report can be downloaded so each flagged invoice can be corrected and then resubmitted for payment. To download the error report in the MCEDT Mailbox select ‘Download’ in the mailbox → select the error report → then scroll to the bottom of the display to select ‘Download’.
The claim file can now be viewed under ‘View MOH Files’. Opening it shows the details of the error report including the invoice number and associated error code. The invoice number can be entered into ‘Billing Correction’ to find the invoice and resolved the error.
4. View MOH Files
Downloaded files from the MCEDT Mailbox can be accessed here. Selecting the file name will open the file up to be viewed.
💡 The downloaded files can be archived once the information has been checked and any corrections made.💡
5. Billing Correction
There are two different ways to correct errors from your error reports.
1. Search for Invoice Numbers in the ‘Billing Correction’ Tab Directly
The invoice number can be copied from the error report and entered in the billing correction tab. Here, the error code and its meaning will be displayed along with the claim itself.
The claim can be edited from this window and the claim status set to "Bill OHIP" so it can be resubmitted to MOH with the next generated claim file.
2. Going into to the ‘Invoice Reports’ Tab and Searching Rejected Claims
Under ‘Invoice Reports’, set the period, provider and type of reports you’re interested in. For Billing correction set the claim type to ‘Rejected’ and select ‘Create Report’.
This displays all rejected claims within the parameters of the search as well as their associated error code.
If you select the invoice number of a claim, the ‘Billing Correction’ window opens for that claim allowing for it to be edited, corrected and resubmitted to MOH with the next generated claim file
💡 Click Here to learn more about billing reports available on Avaros.💡
6. Billing Reconciliation
At the beginning of each month the MOH sends a Remittance Advice (RA) containing your months accepted claims.
To reconcile your RA, go to the 'MCEDT Mailbox' and then Download. Select the RA file you would like to download then scroll down to the bottom and click 'Download'. This RA file will now be available under 'View MOH Files'.
Under the 'View MOH Files' tab, click on the RA file name for it to be ingested and read by the system.
You will then be taken to the ‘Billing Reconciliation’ section where the RA file will be at the top. Select ‘Settle’ (or S35) and the claims covered by that claim file will be settled in Avaros.
Creating OHIP and 3rd Party Billing Claims
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