OHIP Billing Tip #25 - Reconcilliation - Payment Reports


Reconciliation - Payment Reports

The MoH accepts claims for processing up to the 18th of the month and deposits payment on the 10th business day of the following month. All claims should be submitted to the MoH on a weekly basis so that the maximum amount of claims is processed by the cut-off date.

Reconciliation is a monthly process to determine which claims were paid in full and/or adjusted payments and which claims were not paid.  Reconciliation helps to understand why the MoH made the adjustments and which unpaid claims can be corrected and resubmitted to the MoH.

1. On the dashboard under REPORTS & FORMS ->select "Basic Reports" -> select “Claim Summary Payment (Current Month)”


2. This report will show all information about the users current month paid/unpaid claims. There is an option to export as Excel file to save it for personal records. From download drop down menu (see screenshot) -> select “Excel Worksheet”.



3. The report will contain data in columns such as, Accounting ID, patient information, claim details, amount submitted, amount paid, status and explanation codes.



4. Review both columns “$ Submitted” to “$ Paid”. If under column “Status” claim has “Adjusted Payment” status please see next column “Explanation Code” which is the MoH description for the adjusted payment.


5. Scroll to the very bottom of your report to see all MoH explanation codes descriptions.


6. At the bottom of your report you also will find summary totals of your claims:

a) Accounting transactions – Will show an amount if there are few claims that were not processed.  MoH has forwarded you $XXXX as your claims have been submitted on time (before the 18th). This amount will be reduced next month when the unprocessed claims are paid.


b) Totals of patients and services.


c) Grand Total is the amount which will be paid to the user.


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Thank you, Ltd.

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