Billing education resources

The OMA and the government are committed to providing educational resources to physicians and office staff that promote accurate and appropriate payment for medical services and reduce claims payment errors. Educational resources are also available to assist physician awareness and understanding of the physician payment review process.

The Ministry of Health (MOH) and the OMA have jointly established the Education and Prevention Committee (EPC). The EPC's primary goal is to educate physicians about submitting OHIP claims that accurately reflect the services provided, and that are in compliance with the law. The Post Payment Accountability Steering Committee tasked the EPC to develop new billing education resources:

  1. The physician fee-for-service post-payment audit process (PDF)
  2. Assessments and consultations (PDF)
  3. How to get help with billing questions (PDF)
  4. Special visit premiums (PDF)
  5. Requirements for time-based services (PDF)
  6. Understanding the Schedule of Benefits for Physician Services (PDF)

The Ministry of Health, in consultation with the EPC, also offers resources and modules. Read more about the OMA’s current library of billing resources.

Inquiries can be made to

Claims Adjudication Subcommittee

While not part of post-payment accountability, as part of the work with the government in developing policies and procedures guiding the audit process, the OMA insisted on the need to look at pre-payment issues as well.

To that end, the MOH and the OMA agreed to establish the Claims Adjudication Sub-Committee (CASC) as a permanent committee to deal with pre-payment issues, as well as helping to reduce administrative burden for physicians.

The MOH and the OMA agree to continue to make every reasonable effort to ensure a timely and consistent process for adjudication of all in-province OHIP physician claims for payment. To that end, the CASC has been established with representation from both the MOH and the OMA, with the objectives of reviewing and making recommendations around:

  • the claims submission process
  • the automated Medical Claims Payment System (MCPS), such as the OHIP system “Medical Rules” and error/explanatory codes; and
  • the claims adjudication process, such as manual reviews and remittance advice inquiries (RAIs)

Inquiries can be made to