Claims Submission Ontario Health Insurance Program
Resource Manual for Physicians
 
4.4   Submission of Claims

There are three types of claims a physician will submit :

  • Health (HCP);
  • Workplace Safety Insurance Board (WCB);
  • Reciprocal Medical Billing (RMB).
HCP Claim

Health claims are claims for services rendered by physicians or private medical labs to a patient with Ontario health coverage.

  • Payment program "HCP".
  • Payee - "P" for pay provider.
  • Payee - "S" for pay patient.
Note :   Payee is dependent on whether you opted in or opted out when you registered.

WCB Claim

Workplace Safety and Insurance Board (former Workers' Compensation Board (WCB)) claims are for services rendered to patients with Ontario health coverage who have work related injuries.

  • Payment program is WCB.
  • Payee is "P" for pay provider.
  • If the patient is assessed for a non-WCB related problem during a WCB visit (minor assessment only), A008A (Mini Assessment) may be payable. Refer to the Schedule of Benefits, sections General Preamble and Consultations and Visits
  • A008A cannot be billed on the same claim as the WCB service. It must be billed on a separate HCP claim. A008A can be billed only when the WCB claim is for A001A.
  • If the physician bills any service on a WCB claim other than a minor or partial assessment, no other assessment can be submitted as an HCP (MOH) claim.
Note :   Other than the payment program, the information required to bill is the same as for HCP claims.

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