Claims Submission Ontario Health Insurance Program
Resource Manual for Physicians
 
4.6   Reconciliation and Payment

Your RA may contain codes that indicate if a service has been reduced or disallowed because of medical rules in our mainframe computer which control the payment of claims (refer to section - Explanatory Codes).

Inquiries on your RA report should be submitted within one month and no later than six months from the date of service.

New providers can complete an application for direct bank deposit to receive regular monthly payments. These arrangements can be made through the Provider's Registry section in your local ministry offices.

Information updates will be transmitted via the message facility of the monthly Remittance Advice Report. It is important that your reconciliation software allows you to read information displayed in the RA message facility. Please read all communications to ensure you are up-to-date on topics relevant to your practice. Copies of communications should be kept for reference.

4.7   Inquiries

In the event of no payment, over payment or under payment of a claim, you are required to submit a Remittance Advice Inquiry (form 0918-84). Complete all areas of the form and mail or deliver it to your local ministry office.

4.8   Electronic Data Transfer

The Electronic Data Transfer (EDT) service is a vehicle for the electronic transmission of files from your personal computer (PC) to the ministry's mainframe computer. EDT has specific technical requirements and is currently accessed via a direct dial telephone call to which long-distance charges apply if you are outside the Kingston area.

There are currently two applications within the EDT service that the ministry offers :

  • Fee for Service Medical Claims.

Submit your file of fee-for-service medical claims for processing via EDT and receive your claims reports in your EDT mailbox.

  • Overnight Batch Eligibility Checking (OBEC).

This application enables health care providers to verify the eligibility, status of a health number and version code before a health service is provided.

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