Submitting Stale Dated Claims
IMPORTANT: Effective April 1, 2023, the claims submission period for OHIP fee-for-service insured and related services is adjusted from six months to three months from the date a service is rendered in Ontario. This applies to the services rendered on or after April 1, 2023.
For the services rendered prior to April 1, 2023, claims must be submitted to the MoH within 6 months from the service date. If the 6 months deadline is missed the claims become stale.
Before submitting a stale dated claim you must first send a written request with explanation of delayed submission to the MOHLTC (ClaimsManagement@ontario.ca). A Claim Services Branch Manager will review the letter and approve or deny your request.
When attempting to submit a claim that is over 90 days old, a pop-up window will show when you click the Save and Submit button. Claims should be first submitted through the regular claim submission process to be returned with the VJ7 error message (Select "I have not obtained MOH approval...").
If the stale dated claim approval is received and you are advised to submit the claim through the “stale dated claim process” by the MoH, you can select the option “I have obtained MOH approval to submit this claim as stale dated” and submit the claim.
The system will visually mark on the claims page that the record is stale dated.
If your claims have not been returned by the MoH with the VJ7 error message or you have been advised to submit the claims through the regular process (i.e. not to flag the claim as “stale dated”), please select the option: “I have not obtained MoH approval and would like to submit this claim through the regular process” and submit the claim.
Note: Please make sure a batch number is received after 3 days of submission. Otherwise, contact the Ministry to confirm if the claim is received.
For more billing tips, please check out our OHIP Billing Tip Library.
Questions? Check under the HELP tab or send an email to support@mdbilling.ca