22. Billing Submission & Reconciliation

In this section, we'll go over the billing cycle for OHIP insured invoices in Avaros.

This involves submitting OHIP billing Claim Files to the Ministry of Health using MCEDT, confirming that the Claim Files have been received by the Ministry by downloading the Batch Edit report, and finally correcting any errors and reconciling outstanding invoices against your monthly Remittance Advice.

Submitting OHIP Claims to the Ministry via MCEDT

When you have a group of billing invoices that are ready to submit to OHIP, you can run generate an OHIP file simulation that allows you to check for any health card, or fee code errors and correct them before submitting your OHIP Claims File. After running your simulation, you can generate the final OHIP Claims File and submit to the Ministry via MCEDT.

For more information on Submitting OHIP Claims files, check out the video below.

Downloading Batch Edit Reports

Two business days after submitting your claim file, the Ministry will post a Batch Edit Report for you to download confirming that they have successfully received your intact file. This does not mean that all claims in the file will be paid, just that they have been received. Think of it as a "Message Received" status.

To find out how to download and review your Batch Edit Reports, check out the video below.

Correcting Errors

Billing claims can be rejected by the Ministry for a variety of reasons. Many of these reasons involve errors - like an invalid health code, or an ineligible billing code - that can be corrected in the invoice and resubmitted for payment. 

The Ministry provides you with an error report of all errors within two days of receiving a Claims File. To correct errors you can download this error report and correct each flagged invoice and then resubmit them for payment.

To find out more about correcting Billing errors, check out the video below.