At the beginning of the month, you will receive your remittance report from OHIP with updated claim status information.
To view your remittance, navigate to app.dr-bill.ca > Reports > Payments:
Aside from your amount paid for claims, you may see some additional line items on your Remittance that can cause some confusion. This article outlines the premiums and reconciliations that may appear on your remittance to help you fully understand your ministry report.
RECOVERY - AUTOMATED ESTIMATED PAYMENT
If you see this line item on your RA, it's likely that your previous RA included ESTIMATED PAYMENT - UNPROCESSED CLAIMS.
When OHIP has received your claims by cut off but feel they may not have the capacity to process them in time, they will estimate the value of them and "advance" you the funds.
Once the claims are processed on the following RA, OHIP takes the payment back as the actual claims have paid. This is what you see on your current RA - $**** RECOVERY - AUTOMATED ESTIMATED PAYMENT
OMA Dues
There are yearly dues owed to the OMA once you are a practicing physician, if you don't have a payment arrangement set up with them directly they will deduct if from an RA once a year. OHIP is instructed to do so by the OMA itself.
If you'd like more clarification or would like to set up a different method of paying the yearly dues please contact them directly:
UNPROCESSED CLAIMS - ESTIMATED PAYMENT
When OHIP has received your claims by cut off but feel they may not have the capacity to process them in time, they will estimate the value of them and "advance" you the funds.
You may see this on your RA as $***** for ESTIMATED PAYMENT - UNPROCESSED CLAIMS.
Once the claims are processed on the following RA, OHIP takes the payment back as the actual claims have paid.
COVID Recovery Payments
n April 22, 2020, the Ministry of Health established the COVID-19 Advance Payment Program to provide monthly, interest-free loan payments to eligible health care providers to address cash flow issues that may have arisen during the initial stages of the pandemic. (see INFOBulletins 4754, 9142,8161, and 7130).
The MoH made one recovery repayment in April 2021, then paused the recoveries as the province continued to deal with the impacts of COVID-19.
IMPORTANT: Per INFOBulletin 230701, beginning August 2023, recovery of the loan repayments will continue as 12 equal deductions, applied against future OHIP payments, through the Remittance Advice from August 2023 to July 2024 (showing as ‘EMERG ADVANCE (COVID19) RECOVERY’.
COMPENSATION INCREASE
The OMA and ministry had reached an implementation agreement, providing that a lump-sum payment covering the period of April 1, 2024 to December 2024 would be processed and paid on the May 2025 remittance advice (RA). However, as a result of the ministry’s internal payment processing system, it turned out that the May 2025 payment could only include the period of April 1, 2024 to October 31, 2024.
The November and December 2024 lump-sum payment will now be paid no later than the August remittance advice and will include OHIP Claims System and Primary Care Automated Payments as outlined below.
Please see the following bulletin for more information:
OHIP Bulletin 250501
Some additional but less common premiums and reconciliations you may see on your remittance are listed below:
Monthly AFP Redirection:
In Ontario, Alternative Funding Programs (AFPs) may have monthly payments or quarterly payments depending on the specific agreement. For some AFPs, payments are included in the monthly remittance advice, while for others, they are part of quarterly payments and not reflected in individual OHIP billing statements.
Monthly Payments:
For some AFPs,
monthly payments are calculated and included in the monthly Remittance Advice (RA) that physicians or groups receive through the Medical Claims Electronic Data Transfer (MCEDT).
The RA
will reflect the compensation increase payment value at the solo physician or group level.
Quarterly Payments:
For other AFPs, payments are calculated and paid on a quarterly basis.
Telemedicine events: for these groups are included in the quarterly payment and not reflected in individual OHIP billing statements
Age Premiums
Internal Medicine Premiums
Hospitalist Premiums
GP Special Premium
Palliative Care Premium
Blended Fee-For-Service Premiums
Comp Care Capitation
Comp Care Reconciliation
Network Base Rate Payment
Base Rate Payment Reconciliation ADJMT
Please note, our team does not factor in your premiums when calculating your invoice for Dr.Bill services. Your invoice is based only on a percentage of paid claims per billing cycle. You are not being invoiced for these additional lump sum payments.
Dr.Bill reports on your overall payments from OHIP, but as these premiums and deductions are not directly tied to claims when reported on your RA, our team has limited information outside of this article to further assist you.
f you need further assistance with understanding your Remittance, please contact OHIP directly at 1-800-262-6524.
Happy Billing!