6. Billing

[0] Chapter Contents

[1] Billing the Encounter | [2] Billing: The Process | [3] Pre-Invoice Functions | [4] Billing for the Flu Clinic 

[5] INR Billing | [6] EDT Setup | [7] Invoicing OHIP | [8] Invoicing Via EDT | [9] Correcting Billing Errors

[10] Remittance Advice & Report | [11] After the RA Report | [12] Health Card Version Codes | [13] UHIP - WSIB & Refugee

Table of Contents

[1] Billing the Encounter

Provider View Only

FOUR WAYS TO ACCESS:

• From the B on the patient appointment screen
• From the Add Billing button in the ‘Patient’s Detail Record’ window
• From the ‘Billing’ link in the Encounter window, under ‘Clinical Modules’
• From the Billing tab, produce an Unbilled Report and you can bill by clicking the link "Bill [$]" under the heading "Comments".

The billing window will appear. The patients name will be in the upper LEFT corner.

Ontario Billing Screen

British Columbia Billing Screen

PATIENTS STATUS

Patient Status shows whether the patient is active (AC), inactive (IN), deceased (DE), moved (MO), etc.

ROSTER STATUS

Roster Status shows whether the patient is rostered (RO), not rostered (NR), fee for service (FS), terminated (TE), etc.

BILLING TYPE

Below the patient’s name is the Billing Type (NOTE: the program will default to Bill OHIP) For other types such as DO NOT BILL, click on the arrow beside the window to select from the drop down menu.

VISIT LOCATION

The program will default to the Clinic name. For hospital and other locations, click on the arrow for a drop down menu.

REFERRAL

If your program is set-up for specialist billing, you will have a check box beside the Visit Type.

The referring doctor must be in the patient’s Master Demographic area for this to work.

ASSIGNED PHYSICIAN

This is the physician assigned to the patient in the Master Demographics

BILLING PHYSICIAN

Click on the drop down menu to select a physician's name.

VISIT TYPE

Visit Type will default to the clinic. If the encounter was outside the clinic, click on the drop down menu beside Visit Type to select: Out Patient Visit, Hospital Visit, ER, etc. from the drop down menu.

ADMISSION DATE

• Click on the Admission Date link underneath the Visit Type.
• Clicking on the appropriate date of the calendar will put the admission date in the Admission box.

SERVICE, PROCEDURE AND PREMIUM CODES

• Select the checkbox(es) of the codes you wish to bill to your patient
• If a service/procedure/premium is not present and you DO know the code, simply enter it into one of the three boxes under the heading "Other service/procedure/premium codes" and enter the number of units billed.
• If a service/procedure/premium is not present, and you DO NOT know the code: use the code search on the lower right corner of the screen to bill up to three additional codes, then enter the number of units billed.

DIAGNOSTIC CODES

• Click on the link labelled "Diagnostic" to view a list of common diagnostic codes, and choose the appropriate diagnosis
• OR you can do a diagnostic code search in the box below:

DIAGNOSTIC CODE SEARCH

This search engine accepts both diagnostic code numbers and text

• If you know the numeric diagnostic code, type it in the box and click the dx code search button to retrieve it from the data base
• Using text in the diagnostic search engine, type part of the diagnostic word in the box and click SEARCH (using only part of the word will give you a longer list)
• If there is only one match, it will put the diagnosis in the box, if there is more that one match, the program will give you a list from which to select
• Clicking on the number link of the desired diagnostic code will insert it into the bill

SENDING THE BILL

1. Once you have made all your selections, click the CONTINUE button to view what you have billed
2. This gives you the opportunity to EDIT the bill if you forgot something, or CONFIRM the bill as correct.
3. Click CONFIRM to save the billing record for processing and bring you back to the appointment screen

Ontario Billing Record

British Columbia Billing Record

DIAGNOSTIC RESEARCH CODING (2 or more codes)

See Chapter 5: Clinical Modules- Disease Registry for the details on how to add multiple diagnostic codes to a patient's records.

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[2]Billing: The Process

Doctors input billing in OSCAR after seeing patient

• Biller checks for unbilled appointments and prints a report for each doctor to bill

OHIP Simulation

• Run OHIP Simulation, check billing for any billing entry errors before creating and sending OHIP invoice

Submitting Invoice to OHIP

1. Flag any needed invoices for Manual Review and send supporting document with OHIP disks
2. Send digital billing invoice of all FFS, PCN & WSIB encounters for each doctor to OHIP weekly
3. Create digital invoice reports for each doctor & OHIP digital file format.
4. File digital invoice & invoice reports on server (in directory for each submission date)

5. Print Invoice Summary and file & submit Invoice to MOH

Invoice Submission to MINISTRY OF HEALTH - OHIP

Machine-readable Error Reports Received from MOH

Correct billing & Version Code errors received from MOH & resubmit invoice to OHIP

1. Find patient name & phone number in OSCAR & call patient for new Version Code
2. Update information in OSCAR & re-save invoice for resubmission to OHIP

Error Reports Corrected & Re-Submitted to MOH - OHIP

10th - 14th of Month: RA - Remittance Advice Received from OHIP

1. Receive digital file from OHIP (shows detailed report of paid encounters & payment amount for each doctor)
2. Reconcile to OSCAR program
3. Correct any billing errors
4. Mark file for billing archive
5. Archive partial payments from MOH by changing the ‘Billing Type’ to ‘S - Settled/ Paid by OHIP’
6. Run the RA report generator
7. Make adjustments to partial payments
8. File digital copy of RA reports on server

18th of Month Submission to MINISTRY OF HEALTH - OHIP Month End

• Send month end submission to OHIP for next month’s RA payment
• TIME SENSITIVE: must be in by 5 p.m. on the 18th of each month

Revenue Reports To Doctors

Print the UNSETTLED REPORT to check on invoices submitted to the MOH, but not paid

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[3] Pre-Invoice Functions

Before creating OHIP submissions, read through the following checklist:

• Version codes corrected and invoice marked for re-submission
• All monthly monitoring billing submitted (INR’s)
• Search for Unbilled Encounters and bill
• Error report encounters corrected and re-submitted

RECIPROCAL BILLING

1. In ‘Patient Detail Record’, enter the out-of-province health number in the HIN box
2. In ‘HC Type’, click on the drop down menu of the provinces & select the correct province

NOTE: There is a Reciprocal Health billing agreement with all provinces except Quebec. For Quebec patients need to pay cash for the appointment and the patient submits the receipt to the Quebec Health system for re-imbursement.

VIEWING PATIENT’S BILLING HISTORY

1. In the Appointment Screen, click the Search tab
2. Type in the patients name and click Search
3. Click on the Demographic ID for the correct patient to access the ‘Patient’s Detail Record”

OR

1. If the patient has an appointment, click on the M beside the patient’s name on the appointment screen
2. Clicking ‘BILLING HISTORY’ shows a list of the encounters that have been billed with date, bill type, provider and comment column
3. Clicking on the date will allow you to view what was billed for each encounter

• Only billed encounters that have NOT been submitted to OHIP can be unbilled and re-billed

SEARCHING FOR UNBILLED APPOINTMENTS

See Chapter 9-Unbilled Report for instructions on how to create billing reports, which include a list of unbilled patients.

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[4]Billing for the Flu Clinic

BILLING FOR FLU SHOT

OSCAR has developed an easy billing function for special walk-in Flu Shot clinics to eliminate the need to book an appointment or search for the billing code.

From the Appointment Screen

1. Click on the ‘SEARCH’ tab
2. Search for the patient in the normal way by typing in part of the patient’s name and press ENTER. Click on the Demographic ID of the correct patient
3. Click on the ‘Flu Billing’ link under the "Billing" heading on the left side of the Patient’s Master Demographic record. 
   
   
4. The program will automatically default to the diagnostic code 896 for flu shot & the service code G591A for Flu Shot without previous appointment
5. Clicking ‘SUBMIT’ will immediately bill the patient for the flu shot

• You can also click "Submit & Go to Prevention", which brings up the oscarPrevention screen so you can document the vaccination and save it in the patient's E-Chart.

FLU BILLING REPORT

The flu report allows you to print a report to track the amount of flu shots done in the clinic for statistical reasons and for confirmation of the Ministry bonus for Primary Health Care.

See Chapter 9 for details on how to create and print a flu billing report.

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[5] INR Billing

ADDING PATIENT TO THE INR BILLING LIST

This feature is for billing the monthly G271A monitoring for long-term anticoagulant supervision. Set up the list of patients for each doctor by adding each patient via the ‘Add INR’ button at the bottom of the ‘Patient’s Detail Record’. After the patient has been added to the INR list, it is a simple matter of pulling up the list for each doctor and clicking the check box for patients who need to be billed.

1. Pull up the ‘Patients Detail Record’ by doing a SEARCH or by clicking the M icon on the Appointment screen if the patient has an appointment
2. Click on the Add INR button at the bottom of the ‘PATIENT’S DETAIL RECORD’ 
3. Select the doctor for this patient in the drop down menu
4. The default Service & Dx codes can be changed by their code search buttons as required
5. Click on the ‘SUBMIT’ button
6. At the ‘Review INR Billing’, click on the ‘SUBMIT’ button again in order to review the information for accuracy

MONTHLY INR BILLING

1. Click on the SEARCH tab and search for any INR patient’s ‘Patient Detail Record’
2. Click on Bill INR
   
3. Select the doctor from the drop down list
4. Click on the check box beside the patients you want billed this month
5. Click on ‘Generate INR Batch Billing’ button to submit months billing
6. You can now change to another doctor and submit the INR billing for each doctor

NOTE: Monthy INR Billing can also be done in the Administrative View. See Chapter 14 for details.

From the Administration View

1. Click on INR BATCH BILLING
2. You will see all of the patients for all of the doctors in the clinic with ALL PROVIDERS or you can select one doctor to process at a time from the drop down menu
3. Click on the check box beside the patients you want billed this month
4. Click on ‘Generate INR Batch Billing’ button to submit month’s billing

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[6] Billing: EDT Setup

The sending and receiving of the EDT files is done outside of OSCAR, but viewing the files and reconciling the claims is done on the Administration screen of OSCAR. The following information will assist you in registering with the MOH and setting up the initial connection.

REGISTERING FOR EDT SUBMISSION to MOH

Register with the Ministry of Health for EDT service in Ontario, Canada.

Ministry of Health and Long-Term Care

1-800-262-6524; 80 Queen St., 3rd Floor, Kingston, ON K7K 6W7; Kingston: 613-544-7700 ; Fax: 613-544-6310

1. Contact the MOH for your EDT Application package. Complete the application for GONet Electronic Data Transfer EDT Service and EDT Letter of Undertaking and Acknowledgement and mail to the address on the application.
2. OR.... Get EDT forms off the Web at: www.gov.on.ca/MOH/english/pub/ohip/edtguide/edtmanual.html
3. Wait for notification from the Ministry of Health and Long-Term Care that your EDT privileges have been activated. This will take approximately 2 - 4 weeks upon receipt of your application. You will receive an EDT User Manual, and EDT User ID and temporary password.

WHAT YOU WILL NEED

• Modem: the direct dial access supports up to 56K modems
• Dial up communication software (MOH recommendation is HyperTerminal which is part of Windows)
• Telephone line capable of handling data communications
• OSCAR software has the program features to interface with the MOH reports for this process
• Configure your communication software to dial EDT Kingston: 613-544-3883

ADVANTAGES OF EDT

• Faster: supports up to 56K modems as of August 2002
• Easier: direct dial access connects directly to Government of Ontario Network log on screen
• Easier: ability to attach manual review indicator
• Direct: direct data transfer
• Time: error reports in 48 hours
• Time: longer period after 18th of the month cutoff for submissions
• Time: receive RA files and reports from 5th to 7th of the month
• Cost Effective: direct dial access requires no set-up fees or monthly administrative fees.
• Choice of telecommunications provider: select your preferred long distance carrier

POINTS TO REMEMBER

• Downtime of MOH server: Sunday 5 am to 7 am
• Password changed every 32 days
• Must check mail box within 95 days after sign up & check the mail box regularly for it to stay active

SETTING UP THE CONNECTION

1. At the Windows screen, click on the START button
2. Go to PROGRAMS to ACCESSORIES to COMMUNICATIONS to HYPERTERMINAL
3. Click on HyperTerminal & when the screen comes up, type in the name of your session (EDT - OHIP) & select an icon & click OK
4. Enter all of the dialing information with the Ministry EDT number: for Ontario, it is 613-544-3883
5. Confirm your information is correct & click on the ‘DIAL’ button
6. Once you have successfully created a connections session, the program will ask if you want to SAVE the connection set-up, when you exit
7. Close out of the HyperTerminal window and set up the desktop shortcut

HYPERTERMINAL SHORTCUT

1. At the Windows screen click on the START button
2. Go to PROGRAMS to ACCESSORIES to COMMUNICATIONS to HYPERTERMINAL
3. When you get to HyperTerminal, right click on the one you created
4. Click on ‘SEND TO DESKTOP’ to put the EDT - OHIP shortcut on your desktop for future use

SETTING AUTO DIRECTORIES FOR DOWNLOADS

1. Open HyperTerminal by double clicking on the desktop shortcut
2. Click on the CANCEL button of the dial-up for now
3. On the Transfer menu on your computer, click Receive File
4. In the ‘Place received file in the following folder’ box, type the path of the folder in which you want to save the downloaded file (this will hold for future download sessions)

• OR In Windows Explorer, find the directory where you want to put your downloads, copy the path in the address box at the top of the screen and paste in the ‘Place received file in the following folder’ box. (this will hold for future download sessions)
• To begin a HyperTerminal connection from this screen, click on CALL -> CALL & DIAL

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[7] Billing: Invoicing OHIP

CHECKING BILLING BEFORE SUBMITTING TO MOH

Log in as Administrator

1. Under ‘BILLING’, click on OHIP Simulation to give you a report to check the billing for errors before you submit invoices to MOH
2. Select either all providers or individual providers
3. Click on create report (this process takes a few minutes)
4. You can either print this report and go through the invoices one by one or visually check the bills for obvious errors. When finished checking the billing, proceed to creating the MOH invoice disk.

CREATING BILLING FILE TO INVOICE THE MOH

1. Under ‘BILLING’, click on ‘Generate OHIP Diskette’ (if your practice is a group, it will read: ‘Generate OHIP GROUP Diskette)
2. Select either all providers or individual providers
3. Click on ‘CREATE REPORT’ (this process takes a few minutes)
4. When the window comes up with the list of files, you can save the OHIP files to disk to send to the MOH, and the invoice files to a local directory
5. Right click on the OHIP Filename for each doctor - select ‘Save Target As” and send file to the A drive, to save the OHIP file to a disk for submitting to MOH
6. Right click on the OHIP Filename for each doctor - select ‘Save Target As” and send file to a directory created for the invoice date, on your local HD to save the OHIP file as a backup
7. These files now reside on your local server with a local backup on your computer.
8. Set up a directory system on your HD and save each MOH submission in a directory for each invoice date

PRINTING THE INVOICE REPORT

This report is created when the OHIP file is created and saved on the server. A local copy should also be saved to the local HD for reference/backup to research future queries or to print for doctors requesting a hard copy.

In the OHIP report window as above:

1. Right click on the html file for each doctor and click on print a report
2. When you are all finished printing the reports, Right click again and save the report in the directory created for this billing invoice period with the copy of the OHIP file.
3. If you are submitting to the Ministry of Health by disk, you will right click on the OHIP Filename for each doctor - select ‘Save Target As” and send file to your A: and send the disk in to the MOH office.

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[8] Billing: Invoicing Via EDT

CONNECTING TO THE GONET Network

1. Double click the EDT shortcut & then click ‘DIAL’
2. At the GONET screen, type in your login (ALL CAPS) provided by MOH...& enter
3. Type in your password (lower case) ...& enter

• This password must be changed every 32 days (system will prompt you)
• Must be between 8 - 16 characters in length
• Cannot repeat characters (e.g. 01010101 if OK, but not 11001100)
• Cannot repeat the same password within a one-year period

'4.'Press enter to bypass the Ministry Information Screen and begin EDT

FUNCTION KEYS IN GONET & THEIR PURPOSES

You are working in a DOS software in GONET, so these are DOS commands. The mouse doesn’t work.

  OPTIONS----------- FUNCTION KEYS------- PURPOSE
  3 - EXIT----------ESC + 3 -------------Exit to MAIN menu
  4 - BACK----------ESC + 4 -------------To go BACK one page (if more than 10 items)
  6 - FORWARD-------ESC + 6 -------------To go FORWARD one page (if more than 10 items)
  8 - SELNEW--------SHIFT + 8 -----------Select files with a ‘*’ to download or delete
  9 - DELETE--------ESC + 9 -------------Delete files marked with a ‘*’
  10 - DOWNLOAD-----ESC + 0 -------------Download files marked with a ‘*’
  SEL -------------------------------------File selection area (* = selected)
  STAT ------------------------------------File status (U = undelivered & D = delivered)
 

SENDING AN INVOICING

1. At the next GONET screen, select # 3 for ‘Ministry of Health Menu’& Select # 1 for ‘Send Claim File’
2. Press the enter KEY once to get to ‘file name’ & enter the EDT filename created when you ran ‘OHIP INVOICING’ in OSCAR ...& enter again
3. When ‘PLEASE BEGIN UPLOAD NOW’ appears on the screen
4. Go to ‘TRANSFER’ on the Main toolbar and click on ‘SEND FILE’
5. Click ‘BROWSE’ and select the appropriate invoicing file (the name will match the EDT file name you typed in above & click OPEN button & then ‘SEND’ to send your invoice file to the Ministry and return you to the main menu where you can send another file, if necessary, or you can download any files waiting for you in your inbox
6. Press # 4 when finished, to LOG OFF & click CALL & DISCONNECT on the HyperTerminal menu

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[9] Correcting Billing Errors

MACHINE READABLE ERROR REPORTS

The Machine Readable Error Reports will arrive about a week after a disk goes in to the MOH. These are errors that the OHIP computer rejects because it does not meet certain criteria. It is as if these bills have never been received by OHIP. For this reason, it is important to correct the errors and re-submit to OHIP for payment.

What to do with the ‘Machine Readable Error Report’: - Correct the billing errors & re-submit (‘Correcting a Billing Encounter’) - Call patients to correct Version Codes & re-submit the outstanding encounters

CORRECTING VERSION CODE ERRORS

From the Appointment Screen

1. Click on the ‘SEARCH TAB’
2. Type in the patient’s name & (enter)
3. Click on the patient’s demographic number to pull up their ‘PATIENT’S DETAIL RECORD’
4. Call the patient to get the new version code, if it has not already been changed.
5. Changes to the version code are done in the box beside HIN
6. Click ‘UPDATE’ when finished
7. After Version Code errors have been corrected, the encounter also needs to be resubmitted in the ‘Billing Correction’ function in the Administration Screen.

CORRECTING A BILLING ENCOUNTER ERROR & RE-SUBMITTING

In Admin View

1. Under ‘BILLING’, click on ‘BILLING CORRECTION’
2. Type the invoice number in the top box & (enter)
3. The invoice is pulled up as it was sent to the MOH
4. Make the billing correction
5. Change the ‘BILL TYPE to ‘O’ for ‘Bill OHIP’
6. Click on ‘SUBMIT’ to re-calculate the billing correction and mark the invoice to be re-submitted with the next MOH disk or EDT
7. Click ‘SUBMIT’ again if the invoice is correct
8. Click either ‘Correct Another One’ or ‘Close this Window’

The ‘SUBMIT’ button must be pressed to re-calculate any corrections made to the Schedule of Benefits

• Changes to the version code in the ‘Patient’s Detail Record’ will be automatically pulled through to the new bill when you click on the ‘SUBMIT’ button

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[10] Remittance Advice & Report

You will first need to connect to the Ministry GoNet and download the RA files to reconcile to OSCAR billing. See [9] Billing: Invoicing Via EDT for instructions on how to connect the GoNet.

DOWNLOADING FILES FROM GONET

At the ‘Ministry of Health Menu’

1. Select # 1 to ‘DOWNLOAD FILE’
2. Use the up and down arrow keys and select the files you want to download
3. Mark all the undelivered items (U) with a ‘*’ by pressing (shift + 8)
4. Press Escape and then 0 to start the download - the files will transfer to an auto-designated folder
5. Once the download for that screen is complete, the screen will return to the Main Menu to start the process again until all files are downloaded
6. To delete all files already downloaded, press (shift + 8) to select the files again
7. Press Escape and then 9 to start to delete, answer ‘YES’ to delete
8. Press Escape + 3 to exit from the EDT system and you must close out the screen to disconnect the modem

READING THE FILES DOWNLOADED FROM GONET

1. Log into OSCAR Admin Screen
2. Click on ‘EDT Billing Report Generator’ & click ‘Browse’ to find the file on your HD
3. Click on the file
4. Click on ‘CREATE REPORT’ to view and print the report
5. You can use ‘EDT Billing Report Generator’ to view and print all reports other than the RA Report

FOUR TYPES OF FILES TO DOWNLOAD

• Remittance Advice (‘P’ files)

  This file replaces the yellow diskette you received in the mail

• Claims Error Report (‘E’ files)

  This report will be available in your mailbox 2 - 3 days after a submission. You will no longer receive in the mail as a printed document. These files are processed through OSCAR.

• Claims Batch Acknowledgement Report (‘B’ files)

  This report is available the day after a submission and is printed through the OSCAR program. It is a report stating that the submission was received and will list any errors encountered under the ‘Rejection Reason’.

• File Reject Message (‘X’ files)

  The report would replace the Batch Acknowledgement if the MOH could not process the invoicing. An error code will be present stating the problem with the file that was transmitted. VERY RARE.

REMITTANCE ADVICE RECONCILIATION

The RA disks are received from MOH once a month and contain all the PAID patient encounters you have invoiced to OHIP during the previous month. It includes a detailed report of which encounters were paid, how much and any further billing errors that were not caught with the ‘Machine Readable Error Report’.

This process up-loads the information from the disk or EDT file to OSCAR and marks the files as paid.

1. Insert the diskette in the floppy drive or download the RA file from EDT to a local directory
2. Log into the ADMINISTRATION view in OSCAR
3. Click on the ‘BILLING RECONCILIATION’ link under BILLING
4. Click on the ‘BROWSE’ button to select the RA file on the A: drive or the EDT directory
5. Click ‘SUBMIT’ (this process will take a few minutes)
6. Click ‘CREATE REPORT’ to upload the RA file
7. When the list of reports appears, click on the ‘NEW’ link under the ‘STATUS’ column to reconcile the file with OSCAR records. This will mark and archive the paid claims

ACCESSING THE BILLING ARCHIVE

At the end of each year, all the billing files that you have sent to the Ministry of Health will archive automatically. To access these files for checking purposes when correcting bills, click on the ‘GENERATE OHIP DISK’ link and click on ‘SHOW ARCHIVE’.

Remittance Advice Reconciliation Window

EDT CLAIMS BATCH EDIT REPORT

From MOH, November, 2001

• You will receive fast notification of your claims batch acceptance or rejection via the EDT Claims Batch Edit Report. This report acknowledges receipt of each batch in a claims file and notes if the batch was accepted or rejected. The Claims Batch Edit Report is sent usually within 24 hours of a claims file submission.
• This report is your only notification if a batch is rejected or accepted. Rejected batches must be corrected and then resubmitted.
• Your claims Batch Edit Report will show the number of claims and records received, the batch process date and the message showing acceptance or rejection. When a batch is accepted you will see “Batch Totals” or a blank if there is a sub-total line.
• Claims Batch Edit Reports for accepted batches which contain both HCP/WCB and RMB claims will show three lines; namely, one line with HCP/WCB totals, online with RMB totals and one line with batch totals. If only one type of claim is represented, only the batch totals line will appear.
• Rejected batches contain an R and a reason for rejection.
• Examples of claims Batch Edit rejection messages include:

  • Trailer record missing

  • Batch header missing

  • Invalid counts in trailer record

  • Creation date > system date

  • Creation date invalid or not YYYYMMDD

• You must regularly check your mailbox, download and read all your claims output reports, including the claims Batch Edit. The other claims related reports are:

  • Claims File Reject Message - only sent if your entire claims file is ejected, normally sent within hours of claims file submission.

  • Claims Error Report - notifies of rejected claims, normally sent within 48 hours of claims file submission to allow reconciliation of errors and resubmission of claims within the monthly billing cycle.

  • Remittance Advice - normally sent between the 5th and 7th day of the month to allow prompt reconciliation of accounts.

REPORTS

The RA reports show the detailed report of which encounters were paid, any additional errors that got past the ‘Machine Readable Error Report’, a summary report of the current payment, and an OHIP Messaging report.

1. Click on the ‘ERROR’ link and print to correct and re-submit, via Remitance Advice inquiry, any invoices where possible and manually reconcile the remainder that are paid at less or more than invoiced
2. Click on the ‘SUMMARY’ link to see and print if desired all billings paid on this RA report. Clicking the ‘SUMMARY’ link will also calculate the total amount on the next report
3. Click on the ‘REPORT’ link to generate the OHIP Messaging report with the cheque totals breakdown and any Messages sent from the MOH
4. Right click on each of these 3 reports and save to a directory on your hard drive as a local backup of the RA files.

NOTE: These files legally need to be kept for 7 years. Much storage space can be saved by burning the digital file to a CD and keeping in a fire proof box, instead of keeping a paper copy.

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[11] After the RA Report

THE UNSETTLED INVOICE REPORT

After the RA files have been settled and all files backed up, it is a good time to look at invoices in your system that are still unsettled to clean up your files or chase down invoices waiting for a version code before they become stale dated.

1. From the appointment screen, click on the ‘BILLING’ tab
2. Click on the button beside ‘UNSETTLED’ to create a report of invoices that have been submitted, but not paid by the MOH.
3. Select the doctor from the drop down list
4. Click on the ‘BEGIN’ link beside the box for the date of when you want the report to begin
5. Clicking on the date will insert the begin date for the report in the box
6. Repeat with the end date for the report by clicking on the word ‘END’
7. Click ‘CREATE REPORT’

• To generate reports for doctors during that time period, just change the doctor’s name and click ‘CREATE REPORT’
• You can view these encounters directly from here by clicking on invoice number in the ACCOUNT column

• Or you can print the report and then look at them individually from the ‘BILLING CORRECTION’ link

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[12] Health Card Version Codes

Validating with Overnight Batch Eligibility

Many hours are spent in chasing patients for correct version codes to re-submit a bill to the Ministry of Health (MOH). Overnight Batch Eligibility allows you to get a jump on the process. The file is sent to the MOH the night before, and the report is picked up in the morning from the web, allowing the receptionist to approch the patients who have invalid health cards before the appointment. Patients can then be given the information to contact the MOH to rectify the problem.

1. Log in as Administrator
2. Under ‘oscarREPORT’, click on ‘Overnight Batch Eligibility Checking’ link
3. Click on the ‘Begin Date’ link for the calendar to enter the begin date from the appointment screen
4. Do the same to the ‘End Date’ to give the date range that you will be sending to the MOH
5. Click on create report
6. Right click on the file name, select ‘Save As’ and save to the directory you are keeping these files to up-load to the MOH
7. Click ‘Close this Window’

CONNECTING TO THE GONET Network

See [8]Billing: Invoicing Via EDT for instructions on how to connect the GoNet.

SENDING OVERNIGHT BATCH ELIGIBILITY

Send the file just created through GONET. The next morning, access the MOH GoNet again to collect your report.

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[13] Billing: UHIP - WSIB & Refugee

The following contact information is for reference purposes and are not functions of OSCAR. UHIP BILLING

  Welton Beauchamp, Nixon Inc. (WBN) 
  Contacts: Clair (provider registration),  Rachel (claims)
  641 Montreal Road 
  Ottawa, ON K1K 0T4 
  1-800-565-0484 

Submitting to UHIP

1. Put card number in OSCAR in ‘Additional Notes’(for reference)
2. Fill out form completely
3. Patient fills out section 1, 2, & 3 (put holder’s UHIP number in upper right corner)
4. Have card holder sign section 3 and date
5. Put provider’s label on section 4
6. Doctor fills in section 5 with OHIP code and diagnosis, signs and dates
7. Use the OMA Service Fee instead of OHIP

Patient’s Ceiling

The cardholder has $1M for the life of the insurance. The decision is up to the doctor if they want to charge the OMA or OHIP fee schedule. The patient could run out of coverage if they have a major illness.

Registering Doctors

When the first completed form is sent in by a doctor, UHIP will automatically create the doctor’s number. The doctor’s UHIP billing number will be on the first cheque for future invoices submitted.

REFUGEE Billing

Interim Federal Health Certificate of Eligibility
  FAS Benefit Administrators
  Contact: Lianne Backstrom (x 729)
  9th Floor, 9707-110 Street 
  Edmonton, AB T5K 3T4 
  1-800-770-2998
  Web Site for forms: www.fasadmin.com
  (go to Client Info & click on Interm Federal Health)

Submitting Refugee Billing

1. Fill out the Medical Services Claim Form
2. Use OHIP codes and dollar amounts
3. Person sending in the claim can sign by Authorized Signature
4. Unit Label on section #2 above put ‘ATTENTION BILLER’
5. Attach a photo copy of the patient’s Interim Federal Health Certificate
6. Mail to above address

 WSIB BILLING
  Workplace Safety & Insurance Board 
  Contact: Maria Galiarity x2937
  200 Front Street West
  Toronto, ON M5V 3J1 
  1-800-387-5540
  Web Site for forms:www.wsib.on.ca/wsibsite.nsf/public/FormsHealth
 

Details

For all patient visits to the office, we bill the same as an OHIP bill and just flag it at the beginning as a WSIB encounter. They are paid the same as an OHIP claim.

WSIB Forms Completed by Doctor

• Each doctor can apply for their WSIB Billing number before submitting invoices
• The clinical visit of a patient concerning a WSIB claim is processed with other OHIP billing and by changing the ‘Billing Type’ to ‘Bill WSIB’
• This invoicing directly to WSIB is for filling out the WSIB forms
• The form is the invoice when filled out with the appropriate billing code
• There is also payment for letters requested for WSIB. Affix a label to a copy of the letter with the appropriate WSIB code

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