Learn More >

Ministry Status: Activation Status

Ontario Health Insurance Plan

OHIP Bulletins


INFOBulletin

Keeping Health Care Providers informed of payment, policy or program changes

Primary Health Care Services InfoBulletins

To: All Patient Enrolment Models (PEM)

Published by: Negotiations Branch, Ministry of Health and Long-Term Care

Date Issued: October 25, 2017

Bulletin Number: 11182

Re:Consent Status Reporting

Posted Electronically Only

PDF Version Portable Document Format | 1 Mb | 


Roster and Capitation Payment Reconciliation Reporting Changes

Effective October 2017, the "Roster and Capitation Payment Reconciliation Report" has been modified to add a new "Consent Status" column under the "Roster" heading on the report.  This is to assist physicians in their roster management. The status codes reported in the column are explained below and any actions required are described.

The Technical Specifications have been made available to all vendors and updates will be needed to format the report with the changes.

New Consent Status Column

The consent status column will contain information for each patient on the physician's roster and will be reported each month. There are instances where patients have had their consent ended by the ministry due to roster activity processes such as when physicians have changed groups, received rosters from other physicians or patients that turned 16 years old prior to December 1, 2010.

Below are the new consent status codes, their descriptions and any action that may be required with the patient to reinstate consent.

Consent Status Code: Blank
Description: Patient has consent
Explanation: Patient has provided consent
Action:   None required

NOTE:

  1. If the patient status is Pre-member (PME) or FHG Assigned (FHG) the Consent Status column will be blank.
  2. When an enrolment has an end date prior to the month end processing date then the Consent Status will be blank.

Consent Status Code: R
Description: Patient revoked consent
Explanation: Patient has revoked their consent

Action: None required

Consent Status Code: N
Description: Ended by Ministry
Explanation: The ministry ended the patient's consent due to "Consent processing rules."  An example of this would be a patient who was on the physician's roster and turned 16 prior to December 1, 2010.  Previous to December 1, 2010 when patients turned 16 years of age the ministry automatically ended the patient's consent. The ministry implemented a change to processing and patients who turned 16 years of age were informed how to end their consent, if desired.

Another example is a Time Limited Transfers (TLT) processed by the ministry for physicians who receive a time limited transfer of patients from another physician.  The consent status will be "N" until the physician re-enrolls the patient.  Once the patient is re-enrolled the consent status for the patient will be "blank" on the report as the patient has consent.

Action: Have the patient sign a "Patient Enrolment and Consent to Release Personal Health Information" form and submit the appropriate claim trigger enrolment code using the patient's signature date as the service date of the claim.

Consent Status Code: P
Description: Pending
Explanation: The cause of this situation is due to a claim trigger enrolment processed with a service date prior to February 2012. Prior to February 2012, enrolment forms were required to be sent to the ministry to be processed to confirm the patient's enrolment and grant consent.  If the forms were not received the patient would be removed from the physician's roster. The ministry implemented a system change and any enrolments with service dates from February 2012 forward did not require the enrolment forms to confirm enrolment and add consent.  Any enrolment forms with service dates prior to February 2012 that were not processed by the ministry did not have the patient's consent added.

Action: Have the patient sign a "Patient Enrolment and Consent to Release Personal Health Information" form and submit the appropriate claim trigger enrolment code using the patient's signature date as the service date of the claim.

List of "Claim Triggered Enrolment Codes" and corresponding Models:

  • Q200A – Regular enrolled patient (All Patient Enrolment Models except GHC)
  • Q201A – Regular enrolled patient (GHC)
  • Q202A – Patient in a Long Term Care facility (FHN, FHO and BSM)
  • Q205A – Patient is Frail Elderly (GP Focused Care of the Elderly)

For any inquiries regarding the changes to consent reporting please contact the Service Support Contact Centre:



To view Portable Document Format PDF files, you will need to have Adobe Acrobat® Reader installed on your computer. You can download this free software from the Adobe website.

For More Information

Call ServiceOntario, Infoline at:
1-866-532-3161 (Toll-free)
In Toronto, (416) 314-5518
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282
Hours of operation : Monday to Friday, 8:30am - 5:00pm