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Manual Review & RA Inquiry Instructions

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How to create a manual review claim or RA Inquiry (Remittance Advice Inquiry)

The instructions here apply to the following forms:

  • Manual Review
  • RA Inquiry

Manual Review

Certain service codes and combinations require an explanation from the physician to the Claim Assessor in order for the claim to be paid. Examples are:

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

Requirements:

  • A claim must be set under Manual Review - How to create a manual review.
  • Manual Review form must include a short explanation from the physician.
  • Supporting documentation (patient notes), if requested by your Claim Assessor. 

RA Inquiry

The remittance advice inquiry is used to appeal claims that you don't believe have been paid correctly, or to make changes to a claim due to incorrect information.

Follow these seven steps

You can also watch our video tutorial: Forms - RA Inquiry and Manual Review

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 created by MDBilling. You can create the details in the settings section of the software. These details should be set to your practice address where patients or insurance can send you payment.

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

OHIP forms and document detail setting for medical billing

Step 2 - Go to Manual Review / RA Inquiry Form Section

Navigate to REPORTS & FORMS -> Select Manual Review / RA Inquiry

Step 3 - 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 4 - Complete the form by following the instructions on the page

Check off the related service code(s) and enter the remark 

Step 5 - Click "Submit" and generate the PDF form 

Step 6 - Review the form

The PDF form is fillable so you can modify any information as required. 

Step 7 - Fax the form

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

OHIP 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 be shorter or longer to complete).

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

 

 

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