Billing Submission, Error Correction and Reconciliation

This article walks through the full billing routine: simulate, generate, and submit your claims, resolve anything the Ministry rejects, then reconcile the final RA in Avaros. Since MOH reports come back on a delay, the correction step usually happens a few days after submission, and reconciliation is done once a month.

We've linked helpful PDF walkthroughs to this article. Feel free to print them out and keep them handy as a quick reference for each step.

💡 Before you can create an OHIP billing claim file, you need individual OHIP invoices ready to submit. Click here to see how to create an OHIP billing claim.💡

Every Submission Cycle

Step 1: Run the OHIP Simulation and Resolve Flagged Errors

Go to Administration > Billing > Simulation OHIP File. Select a provider and the date range for the claim period you want to simulate.

💡 Any errors will be flagged and appear in the comment section of the billing claims. ‘H’ means either the health card information is incorrect or the patient is from out of province.💡

The simulation flags claims that would be rejected by the Ministry. Correct these before generating the real file.

Step 2: Generate and Submit the Claim File

Once the simulation has run and any errors are corrected, go to Administration > Billing > Generate OHIP File. Select the providers and date range for the billing claims file, then select Create Report.

💡 Leaving the ‘Service Date Start’ field blank will pull in any unsubmitted claims from before the ‘Service Date End’ date.💡

Step 3: Confirm the File Was Submitted

All claim files pending submission appear in the Upload section of the MCEDT Mailbox, found under Administration > Billing > MCEDT Mailbox.

If auto-uploads and downloads are enabled, the system submits these claims automatically on a regular schedule. It's still worth checking this section occasionally to confirm nothing is running into errors.

If auto-uploads and downloads are not enabled (this setting is under Administration > Billing > Manage Go Secure), check off the files you want to send to the Ministry and select Submit. You should see a success message confirming the files uploaded to MCEDT.

After the File Goes Out

Step 4: Check the Batch Edit and Error Report

Two reports become available roughly 48 to 72 hours after each submission.

Batch Edit: Confirms the claim file was received by the MOH. Open it to see the Rejection Reason. If no error code appears there, the file reached the MOH without issue.

Error Report: Lists any errors in the claim file submission, including the invoice number and error code for each. Enter the invoice number into ‘Billing Correction’ to find and resolve it.

If automated MCEDT downloads are off

Go to Administration > Billing > MCEDT Mailbox.
Open the Download folder.
Select your Billing Number.
Check off the files you want.
Scroll down and click Download.

💡Tip: If Enable Automated MCEDT File Downloads is turned on under Administration > Billing > Manage Go Secure, skip this step. The files are already waiting in View MOH Files.💡

Then run each file

Go to Administration > Billing > View MOH Files.
Click the file name to run it in.

💡 You can archive the downloaded files once the information has been checked and any corrections made.💡

Step 5: Correct and Resubmit Rejected Claims

Option 1: Invoice Report

Go to Administration > Billing > Invoice Reports, set the period and provider, and set the claim type to Rejected, then select Create Report.
Open and edit the invoice directly to fix the error.
Change the Billing Status from Submitted OHIP back to Bill OHIP.

The claim then goes out with your next generated file.

Option 2: Billing Correction

You can also search for invoice numbers directly. Go to Administration > Billing > Billing Correction and enter the invoice number from the error report. This displays the error code, its meaning, and the claim itself, so you can make your correction, set the billing status back to Bill OHIP, and move on to the next invoice in the error report list.

Monthly: Reconcile Your Remittance Advice (RA)

Step 6: Settle Claims Against the RA File

At the start of each month, the MOH sends a Remittance Advice (RA) file listing that month's accepted claims. Reconciling against it confirms which claims have been paid.

Go to Administration > Billing > MCEDT Mailbox > Download.
Select the provider's name or group billing number from the drop-down you wish to retrieve the RA for
Check off the RA file and select Download.
Go to Administration > Billing > View MOH Files and click the RA file name to ingest it.

This opens the Billing Reconciliation section with the RA file at the top. Select Settle (or S35) to settle the claims covered by that file in Avaros.

💡Tip: If Enable Automated MCEDT File Downloads is turned on under Administration > Billing > Manage Go Secure, skip the download step, the RA file will already be waiting in View MOH Files.💡

💡 Reconciliation runs on its own monthly schedule, separate from the simulate, generate, submit cycle you run for each batch.💡