The TELUS Collaborative Health Record (CHR) uses statuses to indicate where in the billing process your claim is currently saved. There are statuses that apply before and after your claim has been submitted to MDBilling, and statuses that appear when a claim is returned from the Ministry of Health (MOH) on a Claims Error report or Remittance Advice (RA).
Below is a summary of the the Ontario billing statuses for claims and billing items that you can see and use when you create and submit claims.
When you create a claim in the CHR, the default claim status is either Draft or Ready. See Changing the default billing status for your account for more information.
The bill is saved in the CHR.
You can make changes to the bill.
When the claim is ready to be submitted to MDBilling, you must manually change the status of the claim to Ready to Submit.
Ready To Submit
The bill is complete (ready) and once saved without errors, it is automatically and immediately submitted to MDBilling.
The claim status changes to Submitted.
⚠️ Important: Your claim will not be submitted to MDBilling until the encounter is signed.
Attention Required - with Invalid billing item status
When a bill is saved with status Ready to Submit, and the created bill cannot be submitted to MDBilling (e.g due to a missing diagnosis code, the provider is not integrated with MDBilling, the health card is invalid), the status changes to Attention Required - Invalid.
As soon as your claim is successfully sent to MDBilling, the status changes to Submitted.
📌 Note: You cannot change this status.
Once a claim is submitted to the MOH, it comes back with a status of Completed, Attention Required, or Adjusted:
The claim was paid in full by the MOH.
Attention Required - with Refused billing item status
The claim was returned on a MOH Claims Error report. You should fix it and then re-submit it to MDBilling. See Managing rejected bills from the Claims Error report.
The claim was returned on an RA and was overpaid, underpaid or paid at $0.00.
📌 Note: Claims with an Adjusted status cannot be edited, other than changing the status to Completed or Cancelled. However, we don't recommend changing the status of an adjusted claim, as it affects billing reports.
Updated June 9, 2022