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).<\/p>\n\n\n\n
ontario.ca<\/a><\/p>\n\n\n\n Extenuating Circumstances<\/strong><\/p>\n\n\n\n The MOH may consider payment for stale-dated claims if providers can demonstrate that extenuating circumstances prevented timely submission. Extenuating circumstances are defined as extraordinary and unforeseen events beyond the provider’s control that hindered the submission process.<\/p>\n\n\n\n ontario.ca<\/a><\/p>\n\n\n\n Resubmission of Rejected Claims<\/strong><\/p>\n\n\n\n If a claim initially submitted within the three-month period is rejected and becomes stale-dated upon resubmission, providers should:<\/p>\n\n\n\n Separate submissions are required for each physician or group, depending on how claims are submitted. Requests for different physicians should not be combined in one email.<\/p>\n\n\n\n ontario.ca<\/a><\/p>\n\n\n\n First Submission of a Stale-Dated Claim<\/strong><\/p>\n\n\n\n For claims that have never been submitted and are now stale-dated, providers must:<\/p>\n\n\n\n As with resubmissions, separate submissions are required for each physician or group. Do not combine requests for different physicians in one email.<\/p>\n\n\n\n\n
\n
\n
\n