Table of Contents Ontario Health Insurance Program
Resource Manual for Physicians
 
TABLE OF CONTENTS

Section 1 - Physician Registration

Section Contents
1.1 Overview . . . . . . . . . .   . . . . . . . . . . 1 - 2
1.2 Questions and Answers . . . . . . . . . .   . . . . . . . . . . 1 - 3

Section 2 - Physician Payment and Policy

Section Contents
2.1 Schedule of Benefits Overview . . . . . . . . . .   . . . . . . . . . . 2 - 2
2.2 General Preamble . . . . . . . . . .   . . . . . . . . . . 2 - 3
2.3 Schedule of Benefits Appendices . . . . . . . . . .   . . . . . . . . . . 2 - 11

Section 3 - Payment Integrity

Section Contents
3.1 Overview . . . . . . . . . .   . . . . . . . . . . 3 - 2
3.2 Processes . . . . . . . . . .   . . . . . . . . . . 3 - 2
3.3 Actions . . . . . . . . . .   . . . . . . . . . . 3 - 3

Section 4 - Claims Submission

Section Contents
4.1 Overview . . . . . . . . . .   . . . . . . . . . . 4 - 4
4.2 Methods to Submit Claims . . . . . . . . . .   . . . . . . . . . . 4 - 4
4.3 Process to Register to Submit Claims . . . . . . . . . .   . . . . . . . . . . 4 - 5
4.4 Submission of Claims . . . . . . . . . .   . . . . . . . . . . 4 - 6
4.5 Reports . . . . . . . . . .   . . . . . . . . . . 4 - 11
4.6 Reconciliation and Payment . . . . . . . . . .   . . . . . . . . . . 4 - 13
4.7 Inquiries . . . . . . . . . .   . . . . . . . . . . 4 - 13
4.8 Electronic Data Transfer . . . . . . . . . .   . . . . . . . . . . 4 - 13

Ontario Ministry of Health and Long-Term Care
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