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
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