How do I Read Reports from our billing agent (Full-Service | Concierge Plan)?
CLAIMS SUMMARY PAYMENT REPORT
The Claims Summary Payment Report summarizes your monthly OHIP payments.
Status indication:
Paid - Claim has been paid 100% of the submitted value.
Adjusted Payment - Claim has been paid under or over the submitted value.
Explanation codes:
The report will outline claim particulars for each claim with explanation codes as necessary.
Your billing specialist will provide explanations and seek necessary instructions if there are payment issues.
Group billing under an alternative payment plan (APP) will often have claims with “I2” as the explanation code for processed claims. The specific amount deposited or funding is dependent on your APP.
Financial summary:
The bottom of your report will show a financial summary including any special disbursements or deductions as Accounting Transactions (ex/ age premiums, or MOH percentage reduction against all physician payments). The Grand Total is the dollar amount that will be deposited into the bank account you have designated for OHIP direct deposits
UNPROCESSED CLAIMS SUMMARY
An Unprocessed Claim Summary Report provides an update on pending claims at the time the report is generated. If you have recently submitted claims, you will see them here.
Please note that claims are to be submitted to the MoH by the 18th day (subject to holidays and weekends) to be considered for payment in the next month.
The claims listed in this report will fall into one of the below categories:
Saved = Claims were recently loaded and will be submitted to the MOH soon.
Submitted = submitted to the MOH and awaiting payment.
Unsubmitted = in the queue awaiting transmission to the MoH via MCEDT.
Billing Importer Error = requiring amendment prior to initial submission to the MOH or a non-OHIP claim.
Rejected = claims previously submitted but requiring amendment and re-submission to the MoH.
Rest assured, your billing specialist will address claims that have been rejected or that are in Billing Importer Error status. He/she will also monitor the progress of claims that have been submitted to the MoH and are awaiting payment.
Feel free to contact your billing specialist if you have any comments, questions, or concerns regarding an unprocessed claim.