Ontario Health Insurance Plan
Resources for Physicians
On this page you will find learning materials that will help physicians bill OHIP.
This information requires knowledgeable interpretation. It is intended primarily for members of the professional health care community.
Physicians are responsible for understanding and complying with payment requirements for any and all claims submitted to OHIP using their billing number.
Education and Prevention Committee - EPC Billing Briefs
- Billing for OHIP Services - Resources for Physicians
- Trauma Premium (E420)
- Virtual Care 1: Comprehensive and Limited Virtual Care Services
- Virtual Care 2: Terms and Conditions
- Submission of Claims for Surgical Procedures [NEW Resource]
- Attendance at Labour and Delivery and Sole Delivery Premium [NEW Resource]
OHIP Registration and Billing Number Maintenance
- OHIP Billing Number Registration
- Physician Registration
- Getting ready to practice in Ontario
- Applying for an OHIP billing number
- Welcome package and GO Secure registration
- Designation instructions
Payment and Schedule of Benefits
- How to Get Help with Billing Questions
- Understanding the Schedule of Benefits for Physician Services
- Overview of the General Preamble - Schedule of Benefits for Physician Services
- Schedule of Benefits [Current Version]
- OHIP INFOBulletins
Guidance on Specific Billing Matters
Payment Accountability
- Physician Fee-For-Service Post-Payment Audit Process
- Summary of Physician FFS Post-Payment Audit Process
Electronic Business Services
- Medical Claims Electronic Data Transfer
- eSubmit for Supporting Documents, Remittance Advice Inquiries and Additional Information Requests
- Welcome to eSubmit [NEW Resource]
- Health Card Validation Reference Manual
Submission of Claims
Patient Eligibility and Health Cards
Note
Claims for payment submitted to the Ontario Health Insurance Plan (OHIP) must comply with the legislative requirements of the Health Insurance Act and its regulations, including the Schedule of Benefits for Physician Services. The ministry ensures compliance with these requirements to claims for payment on behalf of the General Manager of OHIP.
To ensure prompt payment, submitted claims are paid on an honour system after being processed through computerized checks. These initial checks and resulting payment do not mean that all requirements have been met.
The ministry may review paid claims. Should the ministry determine that claims were paid that did not meet requirements (i.e. a circumstance in section 18 (6) of the Health Insurance Act exists), the ministry may seek reimbursement by requesting a hearing of the Health Services Appeal and Review Board (HSARB) to review the payments.
Public Information
