Claims Submission Ontario Health Insurance Program
Resource Manual for Physicians
 
4.   CLAIMS SUBMISSION

4.1   Overview

This section provides an overview of the claims submission process, including :

  • methods to submit claims;
  • process to register to submit;
  • submission of claims;
  • reports;
  • reconciliation and payment;
  • inquiries.
4.2   Methods to Submit Claims

Claims must be submitted in machine readable format. The Machine Readable Input (MRI)/Machine Readable Output (MRO) system was established by the Ministry of Health and Long-Term Care to facilitate and expedite processing of health data, including claims for medical services. With this system, health care providers submit information via Electronic Data Transfer (EDT), on diskette, magnetic tape or tape cartridges. Providers receive information from the ministry regarding the claims in the same medium as the claims are submitted.

EDT submission is preferred by the ministry over diskette. Effective January 01, 2003, physicians or medical laboratories registering with the ministry for the first time must submit claims via EDT. EDT confirms receipt of your claims files immediately and transfers claims reports to you quickly. The EDT service is available 24 hours a day, seven days a week.

For further information on EDT, refer to the ministry website at: http://www.health.gov.on.ca/english/providers/pub/ohip/edtguide/edt_mn.html

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