How to create a manual review claim or RA Inquiry (Remittance Advice Inquiry)

The instructions here apply to the following forms:

Certain service codes and combinations require an explanation from the physician to the MoH in order for the claim to be paid. Examples are:

Requirements:

The remittance advice inquiry is used to appeal claims that you don't believe have been paid correctly, or to make changes to a claim due to incorrect information.

Follow these seven steps

You can also watch our video tutorial: Forms - RA Inquiry and Manual Review

Step 1 - Complete the "Form & Document Details" Section

(if you have completed this step, go to Step 2)

The details you enter will be pre-populated in the PDF forms created by MDBilling. You can create the details in the settings section of the software. These details should be set to your practice address where patients or insurance can send you payment.

Top Right --> Settings --> Form & Document Details

Step 2 - Go to Manual Review / RA Inquiry Form Section

Navigate to REPORTS & FORMS -> Select Manual Review / RA Inquiry

Step 3 - Select the claim by entering the Accounting ID

For RA Inquiries (appeals or corrections) - the claim needs to be processed by MOH first. As such, you can only choose claims in Paid or Adjusted Payment status.

Step 4 - Complete the form by following the instructions on the page

Check off the related service code(s) and enter the remark

Step 5 - Click "Submit" and generate the PDF form

Step 6 - Review the form

The PDF form is fillable so you can modify any information as required.

Step 7 - Fax the form or send through eSubmit
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You will need to fax the forms to the MoH at 905-434-4186.

After faxing your documents, you can follow up the MoH.

MoH toll-free number: 1-800-262-6524, option: 4-1-1

About the eSubmit process

MOHLTC has created an electronic portal to create Manual Review and RA Inquiry forms. This is an alternative to creating PDF forms in our portal and faxing them (depending on your practice, the eSubmit process may be shorter or longer to complete).

At this time, MOHLTC does not provide integration with software vendors. To use the eSubmit portal, you will need to log into your OPS BPS account - more information about eSubmit here.