You should contact a software vendor to determine the most appropriate hardware and billing software that would meet your needs based on your business practices and technical capabilities. OHIP Billing Tip #29 - Reconcilliation - Unprocessed Claims OHIP Billing Tip #4 - Time Saving Tip - EH2 - Version Code Rejection OHIP Billing Tip #44 - Submitting Documentation to These forms are available at: http://www.health.gov.on.ca/en/pro/forms/ohip_fm.aspx 4.5 Reports The following reports are sent electronically from the ministry. Fee allowed according to surgery claim Allowed as repeat assessment - initial assessment previously claimed Allowed as extra patient seen in the home Not allowed in addition to procedural fee Date http://dssoundware.com/error-code/edi-error-report.php
CLAIMS SUBMISSION 4.1 Overview This section provides an overview of the claims submission process, including: method of submitting claims process to submit claims submission of claims reports reconciliation and payment inquiries February 2014 4-4 Version 1.05 The EDT Reference Manual has been prepared to assist you with registering for EDT. If claims are uploaded on a weekend, holiday or at month end, the Error Report is delivered on the next claims processing day. ERF - What Does It Means? this page
Claims Error Report Claims submitted may be rejected for a variety of error conditions. Before you begin submitting claims, you must: complete the Application for GONet Electronic Data Transfer (EDT) Service form (3274-84) and the EDT Undertaking and Acknowledgement form (3279-84). February 2014 4-6 Version 1.07 Patient Information Province Registration Number Two letter code representing the province of the patient s registration Assigned to the patient in his or her province of
Period ENP EPA EPC EPF EPP EPS EP1 EP2 EP3 EP4 EP5 EQ1 EQ2 EQ3 EQ4 EQ5 EQ6 EQ9 EQB EQC EQD EQE EQF EQG Invalid FSC for NP Network billing Invalid Blank HN Claim The telemedicine billing is submitted by a physician who is not registered as a Telemedicine physician. - Not Reg for Telemedicine The telemedicine billing does not include Payment program HCP Payee - P for pay provider Payee - S for pay patient Note: Payee is dependent on whether you opted in or opted out when you registered. Adf Error Code Telecommunication service and associated costs/terms are the responsibility of each EDT user.
Payment program is WCB Payee is P for pay provider If the patient is assessed for a non-wsib related problem during a WSIB visit (minor assessment only), A008A (Mini Assessment) may Ohip Error Code Ac1 The report includes total number of members, breaks down total numbers into member status (e.g. Information updates will be transmitted via the message facility of the monthly RA. This Site Academic Health Science Centre (AHSC) Governance Reports Northern Specialist Alternate Payment Program Governance Reports Primary Care Reports The following enrolment/consent reports are only sent to primary care physicians.
Enrolment/Consent Patient Summary Report This report is a summary of patient enrolment activity to date. Ohip Error Code Mr Claims Error Reports should be retained on file in your office to assist in monthly payment reconciliations. The web page is not intended for use with automated programs or scripts. OBEC Response File OBEC is a Health Card Validation (HCV) method that enables health care professionals to verify the eligibility of a patient s health number/version code before a health service
IHF number not approved for billing on the date specified IHF not licensed or grandfathered to bill FSC on the date specified Insured services are excluded from IHF billings Provider is No HN Req d for FSC Health Number is Invalid HN is Missing Invalid Payment Program Invalid Version Code February 2014 4-21 Version 1.022 CODE EXPLANATION VH8 No Match on DOB A3h Error Code The Error Code is a three-character alpha/numeric code. Ohip Error Code Adf Code Physician 00 Family Practice and Practice in General 01 Anaesthe sia 02 Dermato logy 03 General Surgery 04 Neurosu rgery 05 Community Me dicine 06 Orthopaedic Su rgery 07 Geriatric
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. Resubmit claim and documentation. This report is usually sent within a few hours of the ministry receiving the claims submission. February 2014 4-11 Version 1.012 Governance Reports Governance Reports are only sent to groups that provide specialty services in a hospital or an academic health sciences centre within specific communities. Ohip Error Code 35
Rejected claims must be corrected and resubmitted to be processed for payment. The EDT service will only be available until early 2014 at which time it will be phased out. If claims are uploaded on a weekend, holiday or at month end, the Batch Edit Report is delivered on the next claims processing day. A Claims Error Report provides a list of rejected claims and the appropriate error codes or error report message for each claim.
February 2014 4-10 Version 1.011 Split Claims Error Report The Split Error Report is only available to physicians affiliated with a primary care group. Ohip Error Code Eg1 A computer with telecommunication software is required to access the EDT service and billing software is also required. The web page was implemented in October 2012 and the web service will be available in early 2013.
Refer to the Schedule of Benefits, sections General Preamble and Consultations and Visits A008A cannot be billed on the same claim as the WSIB service. It must be billed on a separate HCP claim. Inquiries on your RA should be submitted within one month and no later than six months from the date of service. Ohip Error Code Df Claims must be resubmitted within six months of the date of service to avoid being rejected as a stale dated claim.
Supporting documentation should be faxed to your claims processing office when the claim is submitted: http://www.health.gov.on.ca/en/pro/programs/ohip/claimsoffice/default.aspx Supporting documentation may include an operative report, or a Claims Flagged for Manual Review form The following services are excluded from WSIB submissions to the ministry: Service codes prefixed by T or V Lab services provided by private medical laboratory facilities Services provided by hospital diagnostic Claims received after the 18th of the month will be processed prior to month end if time and volumes permit. Please resubmit using appropriate code(s) from OHIP Schedule of Benefits 10 Resubmit as RMB Claim 11 Bill Patient or Quebec Medicare 12 Please advise Patient to contact MOH re eligibility /card
not on File Solo health care provider number is not actively registered with the Ministry of Health on this date of service Practitioner number is Midwife (700000-722899) referral only Claims submitted Please read all communications to ensure you are up-to-date on topics relevant to your practice. Error codes may be reported at the header level of a claim and/or at the item level. On S/D EQK A100 billed with a specialty code other than 00. - MNI Does not Meet Criteria EQL EQM EQN EQS ERF ESD ESF ESH ESN ET1 ET4 ET5 HCC
Rejected claims shown on the Error Reports are returned during the processing month. Inquiries should be submitted to your claims processing office on a Remittance Advice Inquiry form (0918-84) which is available online at: http://www.health.gov.on.ca/en/pro/forms/ohip_fm.aspx February 2014 4-13 Version 1.014 4.8 Province/Territory Codes PROVINCE/TERRITORY Not registered for PA PA4 PA5 PA6 R01 R02 R03 R04 R05 R06 R07 R08 TM1 TM2 TM3 TM4 TM5 TM6 TM7 TM8 V02 V05 V06 V07 PA Registrn on S/D Claims Submission Ontario Health Insurance ProgramResource Manual for Physicians 4.5 Reports Depending on your method of claims submission, there are four different reports you may receive, namely: File Reject