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OHIP: Fix Rejected Claim

OHIP will send a response file and quite often there will be errors that need to be addressed, such as the wrong billing code was used or you are missing the address, etc. This document will explain how you should fix the issue. 

1. Print the report for easy access

  • Click Management Tab
  • Click e-Claims
  • Select OHIP
  • Select Date Range
  • Click GO
  • Right-click the Response file
  • Click Print -> Exceptions Report

2. Void the Claims that were rejected

  • Open the Client Folder
  • Click Records Tab
  • Click Payer Tab (below)
  • Right-click the rejected claim
  • Click Void

Only cancel the transfers if you need to change something with the procedure code, procedure date, etc. If you are simply fixing the clients address, PHN, etc. do NOT cancel the transfers.

3. Fix the problem

Problem with Procedure

For example, wrong practitioner, wrong procedure code, wrong appointment date, etc.

  • Ensure Transfer is cancelled
  • Reverse Charge
  • Change Practitioner, Procedure Code, Date, etc.
  • Charge Procedure

Problem with Client Profile

For example, incorrect PHN version code, wrong

  • Go to Client Folder -> Profile Tab
  • Click Edit Profile
  • Make changes
  • Click Save Profile

You do NOT need to create the claim at this time. The next time you do your standard submission process the claim will be created and added to the submission automatically.

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