OHIP Billing Basics for New Physicians

Starting your medical practice in Ontario means navigating the OHIP billing system. Whether you're a new graduate or relocating from another province, understanding how fee-for-service billing works is essential to getting paid for the care you provide.

Getting Set Up

Before you can submit your first claim, you'll need:

• OHIP Billing Number: Issued by the Ministry of Health. Apply through your Local Health Integration Network (LHIN).
• Group Number: If you're joining an existing practice, your group will have one. Solo practitioners get their own.
• MCEDT Access: The Medical Claims Electronic Data Transfer system is how claims reach OHIP. You'll need EDT software or a billing platform like SnapBill to submit.

Understanding Fee Codes

OHIP uses a standardized set of fee codes published in the Schedule of Benefits (SOB). Each code corresponds to a specific service:

• Consultation codes (A-prefix): A003, A004, A007 — for initial assessments
• Visit codes: A001 (minor), A003 (intermediate), A004 (comprehensive)
• Procedure codes: Vary widely by specialty
• Diagnostic codes: 3-digit OHIP codes (not ICD-9) that describe the reason for visit

The SOB is updated periodically. Staying current is critical — using outdated codes leads to rejections. See our guide on recent OHIP fee code updates for the latest changes.

Common Mistakes to Avoid

1. Wrong diagnostic code pairing: Certain fee codes require specific diagnostic codes
2. Duplicate submissions: Submitting the same claim twice results in automatic rejection
3. Missing health card validation: Always verify the patient's health card is valid before billing
4. Exceeding daily maximums: Some codes have limits on how many times they can be billed per day

The Billing Cycle

OHIP processes claims on a monthly cycle:

• Claims submitted by the 18th are processed for payment by the 15th of the following month
• Claims submitted after the 18th may roll to the next cycle
• Rejections appear in your Remittance Advice (RA) — learn how to read your RA

How SnapBill Helps

SnapBill automates the tedious parts of OHIP billing:

• Photo capture turns patient lists into claims automatically
• Automated validation catches errors before you submit
• Bulk processing handles your entire day sheet in one tap
• Reconciliation matches payments to claims so you never miss a discrepancy

All starting at just 0.2% commission — the lowest rate in Ontario.

---

Have questions about getting started with OHIP billing? Sign up for SnapBill and start billing smarter.