Guide to handling OHIP stale-dated claims effectively

In Ontario, healthcare providers must submit claims to the Ontario Health Insurance Plan (OHIP) within three months from the date a service is rendered. Claims submitted after this period are considered "stale-dated" and may be refused payment by the Ministry of Health (MOH). ontario.ca Extenuating Circumstances The MOH may consider…

What is OHIP Error Codes?

When submitting billing files to the Medical Claims Electronic Data Transfer (MC EDT) system in Ontario, understanding OHIP error codes is essential for efficient claims management. These error codes fall into two main categories: Rejection Codes and Explanatory Codes. Below, we break down each type and provide examples to help…

Understanding OHIP Rejection Code AT3: No Patient-Physician Relationship

The OHIP rejection code AT3, labeled as "No Pat-Phys Relationship," can initially seem misleading. However, its implications are critical for billing compliance when it comes to virtual health care services in Ontario. Clarifying the Requirements According to Bulletin 221203 — Virtual Health Care in Ontario (source), comprehensive virtual care services…

Understanding the Differences Between OHIP Diagnostic Codes and ICD Codes

In the healthcare system, diagnostic coding is essential for standardizing the identification of medical conditions, billing purposes, and effective communication among healthcare providers. In Ontario, the Ontario Health Insurance Plan (OHIP) utilizes its own system of diagnostic codes for healthcare services. These codes, however, are often based on or derived…

OHIP Billing: Common Rejection Codes Related to Referring Physicians and How to Avoid Them

When submitting claims to OHIP, one of the common areas of rejection pertains to errors with referring physician information. Understanding the most frequent rejection codes and implementing preventative measures can significantly improve claim approval rates. Below, we explain these codes, their causes, and how RexEMR minimizes such errors. Common Rejection…

OHIP Rejection Code List

OHIP rejection codes are essential for identifying issues in submitted claims, as they provide specific reasons why a claim was denied or rejected. Each code corresponds to a unique problem, such as incorrect patient information, missing documentation, invalid billing codes, or service eligibility errors. Understanding the descriptions and explanations of…