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Manual Review & RA Inquiry Instructions

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 The instructions here apply to the following forms:

  • Manual Review
  • RA Inquiry

 

Background:

Manual Review - certain service code(s) and combinations require explanation from the physician to the Claim Assessor. Examples are:

  • Two consults conducted on the same day
  • Specific surgical procedures

     Requirements:

  • Claim must be set under Manual Review - more information here.
  • Manual Review form must include a short explanation from the physician.
  • Supporting documentation (patient notes), if requested by your Claim Assessor.

 

RA Inquiry  - appeal claims that you don't believe have been paid correctly, or to make changes to a claim due to incorrect information.

 

Follow the Five (5) steps:

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. This should be your business/ practice address where patient or insurance can send you payment.

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

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Step 2: 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 3: Populate the form & generate the PDF form

Follow the instructions on the page.  Select the code(s) you want to include in the form.

 

Step 4: Review PDF form

The form is created in "fillable" PDF.  Complete any missing information as required.

 

Step 5: Fax the form

You will need to fax the forms to your district office:

District office fax numbers:

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

After faxing your documents, you can follow up with your Claim Assessor:

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

  • Provide your billing number

 

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 take shorter or longer time to complete).

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

 

 

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