OHIP: Setup

Click Here to register with OHIP and learn about their processes.

1. Add e-Claim Explanation Codes

• Click System Setup Tab
• Click Billing
• Click eClaim Explanation Code

Import the eClaim Explanation Codes using comma as the delimiter.

2. Add Procedure Codes

• Click System Setup Tab
• Click Clinical
• Click Procedure Codes

Import the Procedure Codes using comma as the delimiter.

3. Add Diagnostic Codes

• Click System Setup Tab
• Click Clinical
• Click Diagnostic Codes

*Note: only 4 numeric digits accepted (for example, 1234)

Import the Diagnostic Codes using tab as the delimiter.

4. Create Payer

• Click Payers Tab
• Click Payer Administration
• Create new Payer

General Tab

Name: Ministry of Health

Limits Tab

Max Covered: Unlimited

Max Treatments: 100

Deductible: 100

5. Create eClaim Agent

• Click System Setup Tab
• Click Billing
• Click e-Claim Agent
• Create new e-Claim Agent

General Tab

Name: OHIP

Locations: Select all OHIP Locations

Payers: Select Ministry of Health

Setting Tab

e-Claim Layout: OHIP

e-Claim Web Site: https://www.edt.health.gov.on.ca

Submission/Response Folders: Create folders on desktop

Agent Office Location: Choose correctly

6. Add Billing IDs to Location

• Click System Setup Tab
• Click Organization
• Click Clinic Locations
• Edit Location
• Click Billing IDs Tab
• Add Location ID for Payer
• Add Location ID for e-Claim Agent

Use the code that OHIP will send the money to.

7. Add Billing IDs to Practitioners

• Click System Setup Tab
• Click Organization
• Click Resources
• Edit Resource
• Click Payer Billing ID Tab
• Add Billing ID for Payer (same code as step 6)
• Format: XXXXX-XX

8. Create Physician Referrals

• Click System Setup Tab
• Click Organization
• Click Resources
• Add Resource

Profile Tab

Check Active

Check Person

Check Practitioner

Check Refers

Fill in Last Name

Fill in First Name

Payer Billing IDs Tab

Add Billing ID for Payer

Format: XXXXXX 00

9. Create Hospitals

If the client has a Hospital reference number you will need to attach that to the client.

• Click System Setup Tab
• Click Organization
• Click Resources
• Add Resource

Profile Tab

Check Active

Check Refers

Check Hospital

Fill in Name

Payer Billing IDs Tab

Add Billing ID for Payer

Format: XXXX

Use the Master Number from the OHIP Hospital ID list. (use 2016 Master Numbering System Codes XLS)

10. Assign Procedure Codes to Appointment Types

• Click System Setup Tab
• Click Clinical
• Click Appointment Types

Add/Edit an Appointment Type

Procedures Tab

Add Procedure Code

11. Client Details

The following fields are required...

Profile Tab

Edit Profile

First Name

Last Name

Date of Birth

ID (Public Health Number)

Format: XXXX XXX XXX AA

Address

Records Tab

Edit Treatment Plan

Resource Referral (*Required)

Referring Hospital (If Applicable)

Primary Diagnostic Code

Billing Tab

Add Payment Plan

Payer: Ministry of Health

Insured ID: (Public Health Number)

Format: XXXX XXX XXX AA