New OHIP Billing Specialty - Critical Care Medicine (11)
The Ministry of Health (MoH) has created a new billing specialty designation under the Ontario Health Insurance Plan (OHIP) for Critical Care Medicine (specialty code “11”), effective January 1, 2021.
In order to obtain the Critical Care Medicine billing specialty, the physician must have a sub-specialty in Critical Care Medicine as recognized by the College of Physicians and Surgeons of Ontario (CPSO).
In order to register for the new OHIP billing specialty designation in Critical Care Medicine, please send an email to the Ministry’s Provider Registration Services Unit. The new billing specialty can also be requested by calling the ministry’s Service Support Contact Centre (SSCC) at 1-800-262-6524.
Instructions to bill under the Critical Care Medicine (11):
Registered your "11" designation as per the OHIP bulletin instructions.
Once you receive confirmation from MOHLTC, you can switch your default specialty to "11" - see detailed instructions here.
You will continue to bill as usual for non-specialty codes (ex/ comprehensive services: G55x, G40x, etc..) which our system will submit under the specialty "11". However, for specialty codes (ex/ consults: A475, A135, etc..) you will need to manually change the claims to the appropriate discipline (47, 13, etc..) .
Important: You must be registered with the MOHLTC to bill under a specialty "11", on or before the date(s) of service billed. If you bill codes under a specialty for which you are not registered, the claim will be rejected with rejection code A4D.
For more information about the new specialty eligibility, registration process, and claim submissions, please refer to the OHIP Bulletin 210105.