OHIP billing splits into mechanical work — validation, submission, rejection chasing, reconciliation — and judgement work — which code fits an unusual service, whether a premium applies, whether a reduction is worth disputing. Software is better and cheaper at the first half. A billing agent earns their percentage on the second. The real decision is how much judgement work your practice actually generates.
IntelAGENT offers both as tiers of one system: Self-Service at 0.25% capped at $39.99 a month, Premium at 2% with a dedicated billing agent. See how →
The framing physicians usually start with is "should I do this myself or pay someone". That is the wrong axis, because almost nobody does OHIP billing entirely themselves and almost nobody hands over all of it either.
What each half of the job looks like
| Mechanical — a computer does this better | Judgement — a person does this better |
|---|---|
| Checking a health number's check digit | Choosing between a consultation and an assessment for a borderline encounter |
| Confirming a fee code exists and is current | Deciding whether an unusual procedure has a code at all |
| Catching a premium billed without its base service | Judging whether a special visit genuinely qualifies |
| Downloading every claims error report | Deciding whether a reduction is worth a Remittance Advice Inquiry |
| Matching remittance lines back to submitted claims | Arguing a disputed payment with the ministry |
| Splitting a group remittance back to the rendering physician | Spotting that a physician's case mix has shifted and their coding should too |
Read down the left column and ask how much of your current billing frustration lives there. For most physicians it is nearly all of it.
What each costs
Ontario pricing has settled into a fairly consistent shape:
- Self-service software — around a quarter of one percent of paid claims, frequently with a monthly cap. IntelAGENT's self-service tier is 0.25% capped at $39.99 a month.
- Full-service / agent tiers — a percentage of paid claims, uncapped, because the work scales with the practice. IntelAGENT's Premium tier is 2% of paid claims and includes a dedicated billing agent, rejection handling and support.
The cap matters if you intend to do the billing yourself — a capped percentage stops growing no matter how busy the practice gets. If you want the work done for you, the percentage is what pays the person doing it, and it only moves when your paid claims move. Either way the cost is a known fraction of revenue rather than a salary you have to cover whether the claims go out or not.
Current pricing across Ontario providers: what OHIP billing software costs.
Percentage of what? Check whether the fee is on paid claims or submitted claims. Paid is the fairer basis — you are not charged for claims that were rejected and never resubmitted. Most Ontario providers price on paid, but it is worth confirming rather than assuming.
Where software wins
- Speed of error discovery. A validation that runs before submission catches the problem in seconds instead of in the next error report.
- Completeness. Software downloads every report, every cycle, without a busy week interrupting it.
- Point-of-care capture. An agent cannot bill an encounter you never told them about. Billing from a phone at the bedside is the only reliable fix for unbilled encounters, and that is the largest category of lost revenue. See how to reduce missed OHIP billings.
- Cost that stops growing. With a cap, your billing cost is a fixed line, not a tax on success.
Where an agent wins
- Unusual or complex case mix. Surgical assists, multi-procedure sessions, services with preamble rules that vary by setting.
- Disputes. Preparing a Remittance Advice Inquiry with supporting documentation and following it through is work software can prepare but not finish.
- Time, bluntly. If the honest answer is that you will not open the error reports, an agent who will is worth more than software you ignore.
- Transitions. A new practice, a new hospital, a new specialty — the period when you do not yet know what you should be billing.
An agent still needs the mechanics done. Most billing agents work inside software. The question is whose, and whether you can see it. An agent who bills from a spreadsheet you cannot inspect is a single point of failure with no audit trail.
A way to decide
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Count your distinct service types in a typical month
If most of your billings are a handful of repeated codes — a clinic, an ED shift pattern, a ward service — the judgement half is small and software covers you. If every week brings something you have to look up, an agent pays for itself.
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Ask what you did with last month's error report
If the honest answer is "I did not open it", that is the decision. Either automate the retrieval or hand it to someone whose job it is.
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Work out where your billings cross the cap
At 0.25% capped at $39.99, the cap binds at around $16,000 in paid claims a month. Above that, a capped plan costs the same whether you bill $20,000 or $80,000. Compare that against two percent of the same number.
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Decide whether you want to be able to look
Some physicians want the whole thing invisible. Others want to open a dashboard on a Sunday and see what settled. Both are legitimate; they point at different answers.
Both halves, one system
The reason this is usually framed as a choice is that the two options normally come from two different suppliers. In IntelAGENT they are two tiers of the same system, so you can change your mind without changing your billing.
- Self-Service — 0.25% of paid claims, capped at $39.99 a month. You bill; the software validates against the Schedule before submission, retrieves your error reports and remittance advices over its own MCEDT connection, and reconciles every line back to the claim that produced it.
- Premium — 2% of paid claims. A dedicated billing agent works your claims, rejections and inquiries inside the same system, on the same records you can open yourself. What full service covers.
- The same claims either way. Moving between tiers does not move your data, re-do your MCEDT designation, or create a second source of truth.
- You can always look. Nothing is billed on your behalf from a spreadsheet you cannot inspect — the claim, its rejections and its settled position are visible to you in the web portal and on mobile.
- Billing from the point of care. Neither tier can bill an encounter nobody recorded, which is why entry happens at the bedside rather than from memory at the end of the week.
Three months free on either tier. IntelAGENT has submitted OHIP claims since 2016 for more than 2,000 Ontario physicians.
Frequently asked questions
Is billing software cheaper than a billing agent?
Almost always, yes. Self-service software in Ontario is typically priced around a quarter of one percent of paid claims, often with a monthly cap. A full-service tier with a dedicated billing agent is a higher percentage and uncapped, because a person is doing the work every cycle. IntelAGENT's Premium tier is 2% of paid claims, with the agent, the rejection work and the support included at no extra charge.
What does a medical billing agent actually do?
Selects fee codes from your clinical record, submits the claims, works the rejections, reconciles the remittance and chases anything underpaid. The parts that distinguish an agent from software are the judgement calls: which code fits an unusual service, whether a premium applies, and whether a reduction is worth disputing.
Can I use both software and a billing agent?
Yes. IntelAGENT runs both as tiers of the same system: Self-Service at 0.25% capped at $39.99 a month, and Premium at 2% with a dedicated billing agent working in the same claims you can see. Because it is one system there is one source of truth, which is the practical problem with running software and a separate agent in parallel.
How do I know if my billing agent is doing a good job?
Ask for three numbers: the proportion of submitted claims that were rejected, how many of those were resubmitted and paid, and how many claims aged past ninety days unresolved. An agent who cannot produce those is not reconciling, whatever else they are doing.