Claims Submission Ontario Health Insurance Program
Resource Manual for Physicians
 
4.5   Reports

Depending on your method of claims submission, there are four different reports you may receive, namely :

  • File Reject Message (EDT claims submissions only);
  • Batch Edit Report (EDT claims submissions only);
  • Claims Error Report;
  • Remittance Advice Report.

Generally, reports are issued in the same medium as the claims are submitted.

File Reject Message (EDT Only)

A File Reject Message notifies you if the ministry has rejected an entire claims file. This report is usually sent within a few hours of the ministry receiving the claims submission. If the claims are submitted on diskette, your local ministry office will contact you by telephone.

Batch Edit Report (EDT Only)

A Batch Edit Report notifies you of the acceptance or rejection of claims batches. This report is usually sent within 24 hours of the ministry receiving the claims submission via EDT. If claims are uploaded on a weekend, holiday or at month end, the Batch Edit Report is delivered on the next claims processing day for EDT submissions. If the claims are submitted on diskette, your local ministry office will contact you by telephone.

Claims Error Report

Claims submitted may be rejected for a variety of error conditions. Each file submission processed by the ministry will generate an Error Report (if applicable), therefore, several error reports may be received throughout the month based on the frequency of claims submissions. Claims rejected to an Error Report are automatically deleted from the payment stream. Rejected claims must be corrected and resubmitted to be processed for payment.

A Claims Error Report provides a list of rejected claims and the appropriate error codes (refer to section - Error Codes) for each claim. Error codes appear on the right side of the report under the heading: ERROR CODE. As error codes may be reported at the header level of a claim and/or at the item, rejected claims may have more than one error code assigned (refer to section - Rejection Conditions for further detailed explanation of some error codes).

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