Creating provincial bills (Ontario)

In the CHR, you use Insured Billing to create provincial (OHIP) bills. You create OHIP bills in the CHR and then submit them to MDBilling. From MDBilling you submit the bills to the MOH.

Before you can bill OHIP, you must have a MDBilling account set up. See Integrating your CHR account with MDBilling.

You can create insured bills from the following locations:

an encounter (for providers who want to bill during or after each patient visit)
the patient's chart (for staff or providers who want to bill services without a visit or encounter)
the Visits dashboard (for staff or providers who want to bill from a list of appointments)
the billing dashboard via Quick Billing

Each bill has these fields:

Field	Description
Status	Before a bill is saved, there are two statuses: Draft: your created bill is not ready to be submitted to MDBilling. You can still make changes to the bill Ready to Submit: your created bill is immediately sent to MDBilling. If there are any configured payment tags, these appear at the bottom of the list of statuses. Once a bill is saved, additional statuses are available. See CHR Billing Statuses for more information. 💡 Tip: You can set the default status for new bills. See Setting your default billing status for more information.
Location	If you have more than one clinic location, and location is set to Default: If the bill is linked to an appointment, the appointment's location is selected for the bill. If the bill is not linked to an appointment, the billing practitioner's primary location is selected for the bill. To change the location, click the field, and select one from the list.
Payment Issuer (if you're billing from the Visits dashboard or from the patient's chart) Template (if you're billing from an encounter)	Ensure Ontario Health Insurance Plan is selected for OHIP bills. To make OHIP your default billing item template, see Configuring account insured billing defaults and settings.
Patient/Identification (This field is available only if you're billing from the Visits dashboard or from the patient's chart.)	The patient's information is auto-populated based on the chart or appointment you created the bill from. The patient's health card validation (HCV) status is displayed: A red box appears next to an invalid health card number. A green box appears next to a valid health card number. 💡 Tip: to update the patient's demographic information on the bill, click the patient's name. This does not update the information in the patient's chart. To change the patient's demographic information on the chart (which will then apply to the bill), click the person icon.
Billing Practitioner	If you are a provider, by default your name is displayed. If you are not a provider, you must select a billing practitioner. ⚠️ Important: The billing practitioner must be connected to MDBilling in order to submit bills.
Service Date (if you're billing from the Visits dashboard or from the patient's chart) Visit Date (if you're billing from an encounter)	If you created the bill from the patient chart: If you are logged in as a billing provider and the patient had a recent appointment booked in your schedule, the date defaults to the appointment date. If you are not a billing provider or the patient does not have an appointment booked in your schedule, the service date defaults to today's date. If you created the bill from an encounter: If you are logged in as a billing provider and the patient had a recent appointment booked in your schedule, the date defaults to the appointment date. If you are not a billing provider, the date defaults to the Visit Date specified at the top of the encounter. If you created the bill from the Visits dashboard: The service date defaults to the date of the appointment. 💡 Tip: Click the date to select a different one from the calendar, or to select a date from a list of the patient's Latest Appointments.
MOH Group	If all providers bill under one group, the MOH group number is displayed. If there is more than one group, the first number configured appears as the default. To change the group number for this bill, click MOH Group and select a different one from the list. If the group number is not in the list, select Other and manually type the group number.
Referring Physician Billing Number	If there is a Referring Practitioner specified in the patient's demographics, their billing number appears here. If there is no referring provider specified and the bill requires one, either type the referring provider's billing number or click the magnifying glass icon to search for the provider in your list of contacts. ⚠️ Important: If you are a specialist, this field is required by the MOH for you to receive payment.
Service Location	If you are required to submit Service Location Indicator (SLI) codes, select an SLI code from the list. 💡 Tip: If you have a default service location configured in your MDBilling integration in the CHR, it populates automatically on the bill. ⚠️ Important: If you are using SLI codes, you must enable a setting in your MDBilling portal. See Enabling Service Location Indicator codes for more information. Valid SLI codes are: HDS (Hospital Day Surgery) HED (Hospital Emergency Department) HIP (Hospital Inpatient) HOP (Hospital Outpatient) HRP (Hospital Referred Patient) OTN (Ontario Telemedicine Network) IHF (Independent Health Facility) OFF (Office of Community Physician) PDF (Private Diagnostic Facility) RTF (Rehabilitation Treatment Facility) HOM (Home Visit - Subsequent Patient)
WSIB	If the bill is to be paid by the MOH but is WSIB-related (such as minor assessment because of work injury), click WSIB and select Yes. 📌 Note: Any supporting documentation for the claim should be faxed to the MOH.
Admission Date	If you are creating an inpatient bill, click Admission Date and enter the date you admitted the patient.
Manual Review	You can flag a bill for manual review. By default the Manual Review field is unchecked, to flag the item for manual review click the field. This is useful for fee codes, such as K035, when a provider wants manual adjudication. 📌Note: Any supporting documentation for the claim should be faxed.
Facility	If you are creating an inpatient or outpatient bill, click Facility > Select One..., and search for the institution by name or facility number. 💡 Tips: To set a facility number as a favourite, select the star icon beside it. When you create a bill, starred favourites appear first in the Facility search list. If you have a default facility number configured in your MDBilling integration in the CHR, it populates automatically on the bill.
Specialty	The specialty set in your MDBilling integration appears as the default. If you change the specialty for this bill, click Specialty > Select One..., and search for the specialty by name or code. 💡 Tip: To set a specialty as a favourite, select the star icon beside it. When you create a bill, starred favourites appear first in the Specialty search list.

Updated October 31, 2024