1.4.1.2 The Ontario Billing Process

Doctors input billing in OSCAR after seeing patient

• Biller checks for unbilled appointments and prints a report for each doctor to bill

OHIP Simulation

• Run OHIP Simulation, check billing for any billing entry errors before creating and sending OHIP invoice

Submitting Invoice to OHIP

1. Flag any needed invoices for Manual Review and send supporting document with OHIP disks
2. Send digital billing invoice of all FFS, PCN & WSIB encounters for each doctor to OHIP weekly
3. Create digital invoice reports for each doctor & OHIP digital file format.
4. File digital invoice & invoice reports on server (in directory for each submission date)

5. Print Invoice Summary and file & submit Invoice to MOH

Invoice Submission to MINISTRY OF HEALTH - OHIP

Machine-readable Error Reports Received from MOH

Correct billing & Version Code errors received from MOH & resubmit invoice to OHIP

1. Find patient name & phone number in OSCAR & call patient for new Version Code
2. Update information in OSCAR & re-save invoice for resubmission to OHIP

Error Reports Corrected & Re-Submitted to MOH - OHIP

10th - 14th of Month: RA - Remittance Advice Received from OHIP

1. Receive digital file from OHIP (shows detailed report of paid encounters & payment amount for each doctor)
2. Reconcile to OSCAR program
3. Correct any billing errors
4. Mark file for billing archive
5. Archive partial payments from MOH by changing the ‘Billing Type’ to ‘S - Settled/ Paid by OHIP’
6. Run the RA report generator
7. Make adjustments to partial payments
8. File digital copy of RA reports on server

18th of Month Submission to MINISTRY OF HEALTH - OHIP Month End

• Send month end submission to OHIP for next month’s RA payment
• TIME SENSITIVE: must be in by 5 p.m. on the 18th of each month

Revenue Reports To Doctors

Print the UNSETTLED REPORT to check on invoices submitted to the MOH, but not paid