1.4.1.10 Remittance Advice and Report

DOWNLOADING FILES FROM GONET

At the ‘Ministry of Health Menu’

1. Select # 1 to ‘DOWNLOAD FILE’
2. Use the up and down arrow keys and select the files you want to download
3. Mark all the undelivered items (U) with a ‘*’ by pressing (shift + 8)
4. Press Escape and then 0 to start the download - the files will transfer to an auto-designated folder
5. Once the download for that screen is complete, the screen will return to the Main Menu to start the process again until all files are downloaded
6. To delete all files already downloaded, press (shift + 8) to select the files again
7. Press Escape and then 9 to start to delete, answer ‘YES’ to delete
8. Press Escape + 3 to exit from the EDT system and you must close out the screen to disconnect the modem

READING THE FILES DOWNLOADED FROM GONET

1. Log into OSCAR Admin Screen
2. Click on ‘Upload MOH Files’ & click ‘Browse’ to find the file on your HD
3. Click on the file
4. Click on ‘CREATE REPORT’ to view and print the report

FOUR TYPES OF FILES TO DOWNLOAD

• Remittance Advice (‘P’ files)

  This file replaces the yellow diskette you received in the mail

• Claims Error Report (‘E’ files)

  This report will be available in your mailbox 2 - 3 days after a submission. You will no longer receive in the mail as a printed document. These files are processed through OSCAR.

• Claims Batch Acknowledgement Report (‘B’ files)

  This report is available the day after a submission and is printed through the OSCAR program. It is a report stating that the submission was received and will list any errors encountered under the ‘Rejection Reason’.

• File Reject Message (‘X’ files)

  The report would replace the Batch Acknowledgement if the MOH could not process the invoicing. An error code will be present stating the problem with the file that was transmitted. VERY RARE.

REMITTANCE ADVICE RECONCILIATION

The RA disks are received from MOH once a month and contain all the PAID patient encounters you have invoiced to OHIP during the previous month. It includes a detailed report of which encounters were paid, how much and any further billing errors that were not caught with the ‘Machine Readable Error Report’.

This process up-loads the information from the disk or EDT file to OSCAR and marks the files as paid.

1. Download the RA file from EDT to a local directory
2. Log into the ADMINISTRATION view in OSCAR
3. Click on ‘Upload MOH Files’ 
4. Click on the ‘BROWSE’ button to select the RA file on the A: drive or the EDT directory
5. Click ‘SUBMIT’ (this process will take a few minutes)
6. Click ‘CREATE REPORT’ to upload the RA file
7. When the list of reports appears, click on the ‘NEW’ link under the ‘STATUS’ column to reconcile the file with OSCAR records. This will mark and archive the paid claims

ACCESSING THE BILLING ARCHIVE

At the end of each year, all the billing files that you have sent to the Ministry of Health will archive automatically. To access these files for checking purposes when correcting bills, click on the ‘GENERATE OHIP DISK’ link and click on ‘SHOW ARCHIVE’.

Remittance Advice Reconciliation Window

EDT CLAIMS BATCH EDIT REPORT

From MOH, November, 2001

• You will receive fast notification of your claims batch acceptance or rejection via the EDT Claims Batch Edit Report. This report acknowledges receipt of each batch in a claims file and notes if the batch was accepted or rejected. The Claims Batch Edit Report is sent usually within 24 hours of a claims file submission.
• This report is your only notification if a batch is rejected or accepted. Rejected batches must be corrected and then resubmitted.
• Your claims Batch Edit Report will show the number of claims and records received, the batch process date and the message showing acceptance or rejection. When a batch is accepted you will see “Batch Totals” or a blank if there is a sub-total line.
• Claims Batch Edit Reports for accepted batches which contain both HCP/WCB and RMB claims will show three lines; namely, one line with HCP/WCB totals, online with RMB totals and one line with batch totals. If only one type of claim is represented, only the batch totals line will appear.
• Rejected batches contain an R and a reason for rejection.
• Examples of claims Batch Edit rejection messages include:

  • Trailer record missing

  • Batch header missing

  • Invalid counts in trailer record

  • Creation date > system date

  • Creation date invalid or not YYYYMMDD

• You must regularly check your mailbox, download and read all your claims output reports, including the claims Batch Edit. The other claims related reports are:

  • Claims File Reject Message - only sent if your entire claims file is ejected, normally sent within hours of claims file submission.

  • Claims Error Report - notifies of rejected claims, normally sent within 48 hours of claims file submission to allow reconciliation of errors and resubmission of claims within the monthly billing cycle.

  • Remittance Advice - normally sent between the 5th and 7th day of the month to allow prompt reconciliation of accounts.

REPORTS

The RA reports show the detailed report of which encounters were paid, any additional errors that got past the ‘Machine Readable Error Report’, a summary report of the current payment, and an OHIP Messaging report.

1. Click on the ‘ERROR’ link and print to correct and re-submit, via Remitance Advice inquiry, any invoices where possible and manually reconcile the remainder that are paid at less or more than invoiced
2. Click on the ‘SUMMARY’ link to see and print if desired all billings paid on this RA report. Clicking the ‘SUMMARY’ link will also calculate the total amount on the next report
3. Click on the ‘REPORT’ link to generate the OHIP Messaging report with the cheque totals breakdown and any Messages sent from the MOH
4. Right click on each of these 3 reports and save to a directory on your hard drive as a local backup of the RA files.

NOTE: These files legally need to be kept for 7 years. Much storage space can be saved by burning the digital file to a CD and keeping in a fire proof box, instead of keeping a paper copy.