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

The following services are excluded from WCB submissions to the ministry :

  • Service codes prefixed by "T" (dental) or "V" (i.e., chiropractic, osteopathy, podiatry, optometry, and physiotherapy);
  • Lab services provided by private medical laboratory facilities;
  • Services provided by hospital diagnostic departments;
  • Services rendered to patients registered in other Canadian provincial plans;
  • Services rendered by out-of-province physicians;
  • Fee schedule codes: A008, K018, K021, K051, K053, K061, P004, P006;
  • Charges for completion of form, such as M640 (must be billed directly to WSIB).
RMB Claim

Reciprocal Medical Billing claims are used to bill for services rendered by physicians or private medical labs to a patient insured under another Canadian provincial health coverage plan, excluding Quebec.

  • Payment program - RMB;
  • Payee - P for pay provider.
Note :   Except for the section on patient information all other areas are identical to those on the regular HCP claim.

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