Resources for Ontario Physicians.
At Hype Systems Inc., we're proud to offer Ontario's most comprehensive and efficient online billing software interface. While we've automated numerous mundane tasks related to claim entry and processing, there are OHIP billing requirements that demand expert interpretation. The specialty-specific OHIP billing literature links below are the essential reference guides for successful billing practices.
"Physicians are responsible for understanding and complying with payment requirements for any and all claims submitted to OHIP using their billing number."
In April 2024, we encountered a discrepancy with the Schedule of Benefits (SOB). Initially, on April 4th, 2024, a version of the SOB.zip file was released, but it mistakenly contained the old service fees. Subsequently, on April 8th, 2024, an updated SOB file that accurately reflects the new fee structure was released. At present, the only confirmation of the updated fees we have is through the attached document titled "Fee Code Table 1: Increases by Fee Schedule Code – Physician Services Ministry of Health April 1, 2024." As of the morning of April 9th, 2024, the official "Physician Services Under the Health Insurance Act (PDF)" link on the Ontario government's website still shows outdated fees and payment rules.
HYPEMedical users:
All HYPEMedical OHIP billing servers were updated to incorporate the new fees by noon on April 9th, 2024.
All HYPEMedical OHIP billing servers were updated to incorporate the new fees by noon on April 9th, 2024.
For users of our older billing system, QuickClaim, the updated SOB.zip file is now accessible for download to ensure your system reflects the current fees. Instructions for updating QuickClaim are available via a knowledge base article linked here.
New Feature for HYPEMedical Version 3 OHIP Billing:
We've introduced an option within the HYPEMedical system that allows users to switch between the current and previous SOB fee values.
When completing a claim form, you can select "Previous SOB" on the Patient Search tab to apply fees valid for service dates before April 1st, 2024.
There are many more helpful guides to everything OHIP. Check out: https://www.ontario.ca/document/resources-for-physicians
A condensed description of the service and diagnostic codes is available on HYPEMedical, along with automated alerts and error report descriptions.
Related Articles
What outcomes can I expect for my claim submission to OHIP?
There are four possible outcomes or scenarios: The Four Scenarios Most OHIP claims follow the ideal billing flow shown in the rightmost flow chart (Best Scenario). In the "Best Scenario" a Claim is entered and saved to the UNSUBMITTED status, then ...How do I bill OHIP?
Billing OHIP: Click the Claims button in the main menu, search for a patient, and hit Enter. Enter Service codes, and hit Enter. Search or create the next patient, hit Enter, and Go to step #1. Saving a claim for a new patient will also automatically ...Can HYPEMedical create a stale-dated-claim report as required in bulletin 231001?
We are having issues getting errors paid due to the recent changes. We are getting the error code VJ7 - on claims that are over three months old. Do you have a solution on how to get these processed efficiently? The Ministry states we need to ...How do I delete an OHIP Claim?
I billed the wrong patient, how do I delete that OHIP claim if I have already created a newer OHIP claim with the right patient? In HYPEMedical, claim deletion is available in the three places where you would normally search for a claim: The Claim ...Can I see a patient's billing history as I bill?
Yes, up to 12 month of a patient's billing history is displayed directly on the bottom of the billing form. A patient's complete billing history is displayed one click away in the Patient History tab. The Patient History tab is searchable by date ...