How to Bill OHIP: A Step-by-Step Guide for Ontario Physicians

OHIP billing is simple in outline and unforgiving in detail. Every insured service you provide becomes a claim, the claim goes to the Ministry of Health as an electronic file, and the Ministry pays what it accepts once a month. Most lost income comes from the detail: a code billed with the wrong partner code, a claim submitted after the deadline, a rejection nobody fixed.

This guide walks through the whole process in the order you meet it, with links to the code pages and deeper guides for each step. Fees quoted are the current Schedule of Benefits fees and every code links to its page with the fee history.

The short version

1. Get licensed and get a billing number. CPSO Certificate of Registration first, then the Ministry's OHIP billing number application.
2. Connect to MCEDT. Register for OPS BPS Secure, enrol in MC EDT, and name your billing software or agent as your designee.
3. Learn your codes. Fee codes come from the Schedule of Benefits; diagnoses use OHIP diagnostic codes.
4. Build each claim. Health card number and version code, service date, fee code, diagnostic code, and the extra fields some codes need.
5. Submit within three months, and before the monthly cut-off if you want to be paid next month.
6. Read your Remittance Advice and fix every rejection.

Step 1: Get your OHIP billing number

You need two numbers, and they are not the same thing:

• CPSO number (5 digits): your licence, from the College of Physicians and Surgeons of Ontario once your Certificate of Registration is issued.
• OHIP billing number (6 digits): issued by the Ministry of Health. This is the number on every claim, and the one other physicians use to refer to you. (Here is how to look one up.)

To get the billing number, complete the Ministry's Application for OHIP Billing Number for Health Professionals (form 3384-83). You need a valid Certificate of Registration, an Ontario practice address, and a void cheque or bank details for direct deposit. Processing usually takes two to six weeks and runs longer during the July onboarding peak, so residents finishing in June should apply as soon as their certificate is issued. Questions go to the Ministry's Service Support Contact Centre at 1-800-262-6524.

If you join a group (a family health organization, an emergency department group, an academic practice), the group has its own group number and you will be added to it. Your individual billing number still identifies you on every claim. Our new grad setup checklist covers the full sequence, including WSIB, CMPA and the OMA.

Step 2: Connect to MCEDT

Claims reach OHIP through MCEDT (Medical Claims Electronic Data Transfer). It is also where the Ministry returns everything that comes back: batch edit reports, claim error reports, and your monthly Remittance Advice.

Once your billing number is issued, the Ministry invites you to set up access:

1. Register for OPS BPS Secure (formerly GO Secure), the Ministry's sign-in.
2. Enrol in the MC EDT service using the identifiers the Ministry sends you.
3. In OPS BPS, open Designee Maintenance and add your billing software or agent as a designee, then grant it the MC EDT upload and download permissions.

The designee step is what lets software submit and download on your behalf without your password. What Is MCEDT? explains each piece in detail. In SnapBill, this setup is automated from your settings.

Step 3: Understand the codes

Fee codes

Every insured service has a fee code in the Schedule of Benefits for Physician Services, the Ministry's master list of codes, fees and rules. A fee code is a letter and three digits, plus a suffix that says what role you played:

• A for the physician performing the service (most claims)
• B for a surgical assistant
• C for an anaesthetist

So a general assessment you performed is billed as A003A. The letter at the front is a section of the Schedule, not a specialty: A is consultations and visits, C is hospital in-patient visits, H is emergency department visits, K covers counselling, forms and many premiums, and so on. Browse every code by section.

The assessment ladder

Family physicians bill most visits from a short ladder of assessment codes. Picking the right rung is the single biggest lever on fee-for-service income:

Each rung has its own requirements: what history and examination the Schedule expects, how often it can be billed, and what it cannot be combined with. The A007 deep dive works through the most-billed code in detail, and the top 20 family medicine codes covers the rest of a typical week.

Other areas follow the same pattern. Emergency physicians bill from the H-codes (H102 comprehensive assessment, H103 multiple systems, H104 re-assessment), with the code chosen by the time of day; the emergency medicine billing guide has every tier. Hospitalists bill admission and subsequent visits from the C-codes (C122 and C124, $71.80 each).

Premiums and add-ons

Many services carry a premium on top of the base fee, and these are the codes physicians most often forget:

• Special visit premiums for after-hours and urgent visits (B, C, K and H tables). See the special visit premium guide.
• Preventive care and chronic disease codes such as K131 periodic health visit ($64.25) and K030 diabetic management ($45.75).
• Procedure and visit add-ons such as E080 first visit after discharge ($25.90) and the MRP admission premiums.

The premiums family physicians leave on the table lists the ones worth checking first.

Diagnostic codes

Every claim also needs an OHIP diagnostic code: OHIP's own three-digit code for the main reason for the visit (for example, 250 for diabetes). Use the code for the condition you actually assessed. Some fee codes only pay with particular diagnoses, which is one of the most common causes of rejection.

Virtual care

Video and telephone visits have their own codes and rules, including A101 limited virtual care by video ($20.00) and A102 by telephone ($15.00), plus comprehensive virtual care for patients you have an existing relationship with. See OHIP virtual and telephone billing codes.

Step 4: Build a claim

A claim is one patient and one or more services. At minimum it needs:

• Health card number and version code. The two letters after the number matter: a missing or outdated version code is one of the most common rejections. Validate the card before you bill.
• Patient date of birth.
• Service date for each item.
• Fee code and number of services.
• OHIP diagnostic code.

Some services need more:

• Referring physician's billing number for consultations.
• Facility number and admission date for hospital services.
• Service location indicator for services in settings such as the emergency department or an in-patient unit.
• Payment program. Most claims are HCP (an Ontario health card). Patients with a health card from another province (except Quebec) are billed to RMB, the reciprocal program, which needs the patient's name and province. WSIB claims go to WCB.

Billing software assembles these into the Ministry's fixed-width claim file: a batch header, a header for each claim, a record for each item, and a batch trailer, every record exactly 79 characters. You never see that file, but every field has to be right or the batch is rejected.

Step 5: Submit on time

There are two dates to keep in mind.

The three-month deadline. For services on or after April 1, 2023, OHIP must receive the claim within three months of the service date. Later claims are stale-dated: they are rejected with error VJ7 unless the Ministry approves them for stale-dated processing, which needs a letter explaining the circumstances. A claim that was submitted on time and rejected can still be corrected and resubmitted after the three months. The full rules are on our submission deadlines page.

The monthly cut-off. OHIP pays once a month. Claims accepted by the cut-off, usually the 18th (moved when it falls on a weekend or holiday, and earlier in December), are paid in the following month. The upcoming cut-offs:

Submitting weekly instead of once at month end spreads the risk: a rejected batch on the 17th still has time to be fixed.

Step 6: Get paid and read your Remittance Advice

After each payment run, OHIP posts a Remittance Advice (RA) to MCEDT. It lists every claim paid, the amount, and an explanatory code for anything paid differently from what you billed. Before that, you may also receive:

• Batch edit reports, which confirm each batch was received or reject the whole batch for a file-level problem.
• Claim error reports, which return individual claims that failed the Ministry's checks, each with an error code.

Matching the RA to what you billed is how you find underpayments and claims that were never paid. Understanding your Remittance Advice explains each section.

Step 7: Fix rejections

Rejected claims are income you have already earned. The usual causes:

1. Health card problems: wrong version code, expired card, or a patient not eligible on the service date.
2. Code conflicts: two codes that cannot be billed together, or a code billed more often than the Schedule allows.
3. Missing information: no referring physician on a consultation, no facility number on a hospital service.
4. Wrong diagnostic code for a code that requires a specific diagnosis.
5. Deadlines: a claim submitted after three months.

Each error code tells you which of these it is. OHIP rejection codes explained lists the common ones (EH2, A3H, V21 and more) with the fix for each.

Fee-for-service, shadow billing and groups

This guide describes fee-for-service billing. Many family physicians work in a patient enrolment model such as a family health organization, where most core services are paid by capitation and you shadow bill: you still submit claims, but they are paid at a fraction of the fee and serve to record the care you gave. Services outside the capitation basket are still paid in full. The billing mechanics are the same, which is why accurate claims still matter in a capitated practice.

Emergency department groups and other groups bill under a group number with their own rules for who submits and who is paid. SnapBill for groups covers group billing.

Doing it yourself, with software, or with an agent

You have three ways to get claims to OHIP:

• An EMR with billing built in, if your clinic's EMR includes it.
• Billing software, where you enter claims and the software submits them as your designee.
• A billing agent, who enters and submits claims for you for a percentage of billings.

SnapBill sits between the last two. You photograph a whole patient list or day sheet and the claims are drafted for you. Every claim is checked against the Schedule of Benefits before it goes, health cards are validated, and each Remittance Advice is matched to what you billed so nothing goes unpaid quietly. On Premium, the SnapBill team also reviews claims before submission and corrects rejections for you. Compare OHIP billing software, or see SnapBill vs Dr. Bill.

SnapBill Essentials is 0.2% of paid claims, capped at $34.99 a month plus HST. Premium is 1.5% of paid claims. Every new physician gets three months of Premium free from the day their billing number is activated, and new Ontario grads get months four to six at half price.