Billing OHIP (Ontario Health Insurance Plan) for newborn patients requires attention to specific procedures, as newborns may initially only have a pre-assigned health card number without a version code. This article outlines the entire process, step-by-step, to ensure accurate and efficient billing.
Understanding Newborn Health Card Numbers
- Pre-Assigned Health Card Number:
- When a baby is born, parents are provided with a pre-assigned health card number on the bottom part of the birth registration form, supplied by the hospital or midwife.
- This pre-assigned number can be used for OHIP billing, but it initially does not have a version code.
- Official Health Card Number with Version Code:
- Parents must register the newborn’s health card within 90 days of birth to receive the official health card, which includes a version code.
- If registration is not completed within 90 days, the pre-assigned health card number becomes invalid, and parents must reapply, leading to the issuance of a new health card number.
- OHIP Processing Timeline:
- The process of issuing the official health card with a version code can take up to 8 weeks after registration is completed.
Step-by-Step Billing Process
Step 1: Use the Pre-Assigned Health Card Number
- Submit the claim using the pre-assigned health card number (without a version code).
- Include the appropriate service codes and ICD-10 diagnostic codes for the care provided to the newborn.
Step 2: Manage Rejected Claims
- If the claim is rejected because the version code has been issued, follow these steps:
- Contact OHIP Billing Line: Call to obtain the updated version code for the newborn’s health card number.
- Request Information from Parents: Ask the parents or legal guardians for the updated health card details.
Step 3: Resubmit the Claim
- Update the claim with the correct health card number and version code, then resubmit it to OHIP for processing.
- Claims rejected with the explanation code EV (Check health card for current version) indicate that the health card has been registered but requires resubmission with the version code.
How RexBill Handles This Process Seamlessly
RexBill simplifies billing for newborn patients by allowing claims to be submitted using the pre-assigned health card number without a version code. This eliminates manual guesswork and integrates seamlessly into the existing billing workflow. All other processes, such as adding service codes and ICD-10 codes, function the same as billing for any other patient. RexBill ensures accuracy and efficiency, reducing the risk of claim rejections and saving time for healthcare providers
Important Notes
- Registration Delays:
- Parents have 90 days from the baby’s birth to complete the registration of the health card. During this time, the pre-assigned health card number remains valid.
- If the parents fail to register the card within 90 days, the pre-assigned number becomes invalid, and they must reapply for a new health card number.
- Hospital Follow-Up:
- If the newborn was seen in a hospital, you can:
- Check with the hospital’s Patient Accounts Department for updates.
- Review the patient’s hospital record for any health card updates.
- If the newborn was seen in a hospital, you can:
- Temporary Health Card Numbers:
- Claims can be submitted using the temporary health card number. If rejected, resubmitting with the version code or updated details is necessary.
Tips for Successful OHIP Billing
- Verify Registration Status:
- Confirm with parents or legal guardians whether the official health card has been registered. This reduces the likelihood of claim rejection.
- Follow Up with Parents:
- For delayed registrations, communicate with parents to obtain the updated health card number and version code.
- Track Rejected Claims:
- Regularly monitor rejected claims and address any issues promptly by resubmitting with accurate information.
- Document All Updates:
- Maintain detailed records of communication with parents and any updates from OHIP or the hospital to streamline the billing process.
Conclusion
Billing OHIP for newborn patients involves understanding the nuances of pre-assigned health card numbers and registration timelines. By following the steps outlined in this guide, healthcare providers can minimize claim rejections and ensure smooth processing. Effective communication with parents and diligent follow-ups are key to successful billing for newborn care under OHIP.