Web Based
Medical Billing for Ontario Physicians

OHIP Billing Has Never Been Easier

ClinicAid is the most amazing medical billing software I've ever used. As a medical billing agent I've used every software out there and ClinicAid blows them all away with its slick design and helpful validations. ClinicAid literally saves me hours every month on my submissions, rejection handling and reconcilliation.

I'm so happy I made the switch to ClinicAid and would highly recommend to everyone doing medical billing that they should give it a try.

Brenda-Lee Ryan
BLR Med

How ClinicAid helps MDs billing in Ontario

Automated file sending and retrieval through your own GoSecure account

Automated reconciliation of batch edits, error reports, and remittance advice

Instant service code and dx code search fields with current updated OHIP fee schedules

Fast referral provider OHIP billing number search fields

Submitting claims to OHIP

Medical professionals in Ontario can submit claims to the Ontario Ministry of Health and Long-Term Care (MOHLTC) for medical services provided to patients that are insured through the Ontario Health Insurance Plan (OHIP). Being able to send claims in electronically allows care providers to receive assessment on their claims and get paid for the services provided quickly. The MOHLTC uses the Medical Claims Electronic Data Transfer (MC EDT) system to allow physicians and other medical professionals to directly connect and share data with the Ministry.

What is MC EDT?

MC EDT is a service that allows secure electronic transfer of files between an authorized user and the MOHLTC. Users that have gone through the authorization process with the Ministry of Health are able to either connect directly through the web user interface (a web page), or can use a billing software, such as ClinicAid, or EMR system that connects through the MC EDT web service.

Files that contain claims can be uploaded and remittance advice (RA) files can be downloaded through the MC EDT system, allowing care providers to complete their billing easily online.

Who can use MC EDT?

Physicians, medical office staff, and other care providers, that have gone through the authorization process are able to submit their medical billing through MC EDT. Medical professionals also have the option of designating someone (a billing agent, staff member, or a billing software) to submit claim files on their behalf.

The authorization process consists of getting a GO Secure ID and password that allows care providers to access the MC EDT service with their unique account credentials. Once the GO Secure details are received, physicians will be able to connect directly to submit claims through MC EDT.

Medical billing claims submitted through MC EDT

Once connected to MC EDT, care providers can begin submitting claims for services they've provided to patients. Claims are generally sent in batch files and receive an initial response file back from the system within 24-48 hours of submitting. This initial response file will identify basic errors in claims, such as incorrect version codes on patient health cards, invalid personal health numbers (PHNs), and other easily noticeable errors.

Within a couple of weeks of the cut-off date, a full remittance advice list with assessment for most or all of the claims submitted should be received.

How Ontario's medical billing cycle works

The Ontario medical billing cycle completes on a monthly basis. It follows a general pattern which may be slightly modified based on holidays and other factors. The usual cycle is as follows:

  • the 18th of each month: official cut-off is on the 18th of every month* at 5:00 p.m. EST. This is a soft cut-off which means that any claims received in the following few days will often still be accepted and processed for assessment, if time and volume permits. Otherwise, they will be assessed during the next billing cycle.
  • the beginning of each month, generally by the 7th: the official remittance advice (RA) list is received at the beginning of each month (usually between the 5th and the 7th).
  • the 15th business day of each month: claims sent in before cut-off will be assessed and paid out by the 15th business day of the following month.

The 2015 schedule for cut-off dates is available on the ClinicAid blog.

Submitting medical claims in Ontario using ClinicAid

In ClinicAid, any response files and remittance advice lists received from MC EDT will automatically update the status of submitted claims and identify settled (accepted or paid in full) claims or those requiring action (rejected or underpaid).

Claims are batched in files that are sent in to MC EDT every few hours. ClinicAid also performs eligibility checks in real time and is able to sent in overnight batch checks for users wishing to verify their claims before submitting them in full to MC EDT.

For more instructions on how to get set up with billing in Ontario, please read our Getting Started guide.