How to create a manual review claim
All OHIP claims go through an automated process to check the validity and authenticity. When a claim requires an in-depth assessment by the ministry of health, you have a stale-dated claim or you are billing the same code on the same day, for instance, you will often be asked by your assessor to provide the patient notes for manual review.
To have a particular claim enter into a manual review, select the “Manual Review” box, directly within the claim, and click the “Save & Submit” button.
The user will then need to fax the required notes to their Claim Assessor’s attention. You will need to fax the forms to the MoH at 905-434-4186.
After faxing your documents, you can follow up with your Claim Assessor.
MoH toll-free number: 1-800-262-6524
The process will be the same if you want to submit a manual review for an out-of-province claim.
For instruction on creating a note for manual review in our system, see Manual Review Instructions.
If you do not know the contact info of your Claim Assessor, please refer to Finding Claim Assessor.
For more billing tips, please check out our OHIP Billing Tip Library.
Questions? Check under the HELP tab or send an email to email@example.com