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1.4.1.3 OHIP Pre-Invoice Functions

For Ontario billers: checklist of activities to be completed before OHIP submission For Canadian billers: reciprocal billing provincial codes.

Before creating OHIP submissions, read through the following checklist:

  • Version codes corrected and invoice marked for re-submission
  • All monthly monitoring billing submitted (INR’s)
  • Search for Unbilled Encounters and bill
  • Error report encounters corrected and re-submitted

RECIPROCAL BILLING

  1. In ‘Patient Detail Record’, enter the out-of-province health number in the HIN box
  2. In ‘HC Type’, click on the drop down menu of the provinces & select the correct province
Province
Prov.
Code
Format
Alberta
prior to May/94 = 11 numeric
AB
9 numeric individual registration
(effective Oct/91)
British Columbia
prior to Jan1/91 = 10 or 11 numeric
BC  10 numeric individual registration
(effective Jan/91) family based
Manitoba
MB
6 numeric for the subscriber or family group
Newfoundland
NF
12 numeric individual registration
New Brunswick
NB
9 numeric individual registration
Northwest Territories
NT
8 character individual registration;
ONE alpha - N,D,M or T & 7 numeric
Nova Scotia
prior to Jan/91=8 numeric (family based)
NS
10 numeric individual registration
(effective Jan/94)
Ontario
prior to Jan/91=9 numeric (family based)
ON  10 numeric individual reg. version code
(if applicable) effective Jan/91
Prince Edward Island
prior to Dec/96= 9 numeric (SIN individ)
PE 8 numeric individual registration
(effective Dec./96)
Saskatchewan
prior to April/91=8 numeric (family based)
SK  9 numeric individual registration
(effective April/91)
Yukon
YT
9 numeric individual registration
Nunavut
NU
9 numeric individual registration

NOTE: There is a Reciprocal Health billing agreement with all provinces except Quebec. For Quebec patients need to pay cash for the appointment and the patient submits the receipt to the Quebec Health system for re-imbursement.

VIEWING PATIENT’S BILLING HISTORY

  1. In the Appointment Screen, click the Search tab
  2. Type in the patients name and click Search
  3. Click on the Demographic ID for the correct patient to access the ‘Patient’s Detail Record”

OR

  1. If the patient has an appointment, click on the M beside the patient’s name on the appointment screen
  2. Clicking ‘BILLING HISTORY’ shows a list of the encounters that have been billed with date, bill type, provider and comment column
  3. Clicking on the date will allow you to view what was billed for each encounter
  • Only billed encounters that have NOT been submitted to OHIP can be unbilled and re-billed

SEARCHING FOR UNBILLED APPOINTMENTS

See Reports for instructions on how to create billing reports, which include a list of unbilled patients.

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