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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…
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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…
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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…
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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…
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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…
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Common Patient-Related OHIP Rejection Codes

Ontario’s Health Insurance Plan (OHIP) rejection codes often stem from errors in health card details or mismatched patient information. For many clinics, these errors result in delayed payments and extra administrative work. RexEMR, through its advanced billing system RexBill, has analyzed historical billing records and rejection patterns across various physicians,…
How to Bill OHIP for a Newborn Patient: A Comprehensive Guide
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How to Bill OHIP for a Newborn Patient: A Comprehensive Guide

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…
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Understanding OHIP Cutoff and Payment Dates for 2025

The Ontario Health Insurance Plan (OHIP) operates with strict billing and payment cycles to ensure that physicians are reimbursed promptly for their services. For 2025, we provide a detailed breakdown of the billing cutoff dates, how these dates are determined, and the corresponding payment dates. OHIP Billing Cutoff Dates for…