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How To Flag an OHIP Claim For Manual Review

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How To Flag an OHIP Claim For Manual Review

Question

I am a customer of yours and I have spoken to the Ministry of Health about billing the same code on the same day because of circumstances of seeing individual patients as well as the same patient later in the day in a group setting. They told me that for sure payment will be made but it would be flagged for rejection unless we submit it as a manual review. I know that I can do that on your system but they told me that the billing must go into a stale-dated file in order to be processed properly by them.

Is this indeed what happens when I flag a claim for manual review with your system? Or is there something else I need to do to get the claim handled by the Ministry.

Answer

You can set the claim as manual review via the Manual Review checkbox on the claim. However, this means that you will be faxing your claim assessor your patient notes as well. Claims can only be included in stale date claims if the service date is older than 6 months.

For your manual review letters, MoH district office fax numbers are below:

Toronto 416-314-7518
Hamilton 905-546-8287
Oshawa 905-434-4186

 

If you do not know your district office please contact MoH at their toll free number 1-800-262-6524, they will help you to connect with your Claims Assessor and provide more information.

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