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Ontario Health Insurance Plan

OHIP Bulletins


INFOBulletin

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

Physiotherapy Facilities InfoBulletins

To: All health care providers

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

Date Issued: October 20, 2017

Bulletin Number: 3140

Re: Presenting Health Cards for Health Services and Health Card Validation

Posted Electronically Only

PDF Version Portable Document Format | 1 Mb | 


The purpose of this INFOBulletin is to remind health care providers of the policy regarding the presentation of health cards for health services, and health card validation.

Presenting the Health Card

It is the patient’s responsibility to show a health card, upon request of the health care provider, for the provision of an insured health service. The health card must be valid and belong to the patient presenting it.

OHIP eligible residents are responsible for maintaining the validity of their health card by keeping their information (e.g. mailing and residential address) up to date with the ministry and by renewing their health card before the card’s expiry date.

Transaction Records

A Transaction Record is issued to clients at ServiceOntario centres after a health card transaction (e.g. renewing a health card, changing information, replacing a lost/stolen card) to serve as a temporary health card until the physical card arrives in the mail. A sample Transaction Record is included for reference.

The Transaction Record (with health number and version code) can be presented to health service providers as a record of their health card when obtaining insured health services. The Transaction Record is valid for the length of the health card/version code.
In some cases, an individual may have a transaction record as a formal record of a child’s health card (e.g. in two-home families).

If a health number and version code are presented on a Transaction Record the information should be validated using Health Card Validation (HCV) methods.

Presenting Health Cards for Health Services and Health Card Validation

Validation

Health Card Validation (HCV) allows a health care provider to access the ministry’s registration database to determine if a patient’s health number and version code are valid when presented for health services.

There are various HCV methods available that provide access to the ministry’s database. Health care providers may review each of the methods to determine which most appropriately meets their needs based on current business practices and technical capabilities.

For more information about HCV services, and how to register for HCV, please refer to section 5 of the Resource Manual for Physicians and the Health Card Validation Reference Manual.

Validation can help reduce claim rejects associated with incorrect version codes and patient ineligibility. Validation also reinforces the importance of presenting a valid health card (or transaction record) at the time of service and the patient and provider responsibility to ensure that only eligible individuals receive access to publicly funded insured services/resources.

If validation indicates that there is a health card validity problem or an issue with OHIP eligibility:

  • Ask the patient if he/she has a more recent health card.
  • Direct the patient to visit a ServiceOntario centre to correct the health card/eligibility issue.

If an updated version code is received from the patient, the claim should be amended and submitted for payment.

Note that if a health care provider collects payment from a patient for an OHIP insured service; the provider will be required to later reimburse the patient in full if the patient establishes that they were an insured person at the time the service was provided.

24x7 ServiceOntario Help Desk

Patients may not always present the most recent health card information including the most recent version code when obtaining health services. If a provider cannot reasonably obtain the health card information from the patient or from existing patient records, the ministry, through ServiceOntario, has escalation processes to provide health numbers and version codes directly to providers.
For more information about 24x7 ServiceOntario Help Desk services, please refer to section 5 of the Resource Manual for Physicians.

This Bulletin is a general summary provided for information purposes.  Physicians, hospitals, and other health care providers are directed to review the Health Insurance Act, Regulation 552, and the Schedules under that regulation, for the complete text of the provisions.  You can access this information at www.e-laws.gov.on.ca.  In the event of a conflict or inconsistency between this bulletin and the applicable legislation and/or regulations, the legislation and/or regulations prevail.

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