OHIP billing deadlines and stale dating

The submission window is three months from the date a service is rendered, for services rendered on or after April 1, 2023. It was six months before that, and the longer figure is still quoted in a lot of places. The cut-off dates are set by the ministry and change, so take those from the source. What is worth understanding is the structure, because the structure is what determines which claims in your practice are actually at risk.

The clock starts at the service date

This is the single most important thing and the one most often misunderstood. The window is counted from the date the service was rendered, not from:

• the date you entered the claim into your billing system,
• the date the claim was first submitted,
• the date the patient was discharged, or
• the date a rejection came back.

That last one is the trap. A claim submitted on time, rejected, and left sitting in a rejection queue for weeks is still ageing against its original service date. You do not get a fresh window because the first attempt failed. Correcting a rejection two months after it arrived can put the correction outside the deadline even though the original submission was well inside it.

Which claims actually age out

In practice, stale dating hits a predictable set of claims:

1. Rejections nobody worked

   The largest category by far. The claim was submitted, came back with an explanatory code, and was never corrected. Every week it sits there is a week off the window. See why claims get rejected.

2. Encounters never entered

   A shift billed from memory, a locum week reconstructed late, a stack of paper that did not get typed up. These never enter the system at all, so no deadline tracking catches them. Reducing missed billings covers finding them.

3. Claims waiting on something

   A missing health card number, an unconfirmed referring physician, an admission date nobody could find. Claims held pending information age at exactly the same rate as claims being actively worked.

4. Handover gaps

   Switching billing providers, changing administrators, or a biller leaving. Claims in flight during a transition are the ones that fall between two systems. Switching providers sets out how to avoid the gap.

5. Long inpatient stays

   Where billing is done at discharge rather than as care is delivered, the earliest service dates on a months-long admission can be close to the deadline by the time anything is submitted.

The monthly cut-off is a different thing

The ministry adjudicates claims in payment runs. Claims accepted before the cut-off for a run are adjudicated in that run and appear on that month's Remittance Advice; claims arriving after it go into the next one.

Missing a cut-off costs you timing, not money. It matters if you are managing cash flow or reconciling against an expected deposit, and it matters a great deal if you assume a claim failed because it did not appear on the Remittance Advice you were expecting. A claim submitted a day after the cut-off is not missing; it is in the next run.

This is a common source of false alarms. Before chasing a claim that is not on the RA, check which run it should have been in. See reading a Remittance Advice.

Working rejections against the clock

Because a rejected claim keeps ageing, rejection handling should be ordered by remaining window rather than by when the rejection arrived or how much the claim is worth.

A practical priority order:

• Oldest service date first, regardless of value. A $46.65 claim about to age out is worth more than a $342.25 claim with months left, because the second one will still be there tomorrow.
• Then batches. Rejections often come in families — one wrong facility or group number produces dozens of identical rejections that are all fixed the same way. Doing the family together is faster than doing them in arrival order.
• Then everything else.

If you cannot see remaining window per claim, you cannot do this, which is the practical argument for tracking it rather than eyeballing dates.

What to do about claims that already aged out

Pushing it back through the normal channel just gets it refused again. There are two real routes, and which one applies turns on a single question: did the claim ever reach OHIP inside the window?

It was submitted on time and rejected

This is the recoverable case. A claim submitted within the three months that came back on an error report can be corrected and resubmitted after the window has closed. The ministry asks for supporting documentation proving the original submission was on time — the error report and the claim identifying data — with the corrected claims sent as a stale dated claim file through MCEDT, followed by an email to [email protected]. Do it as soon as possible after the rejection date.

It was never submitted in time

This one is a letter rather than a resubmission, and the bar is high. The ministry will consider paying a stale dated claim only where extenuating circumstances prevented submission, which it defines as extraordinary and unusual events arising suddenly and unexpectedly and beyond the provider's control. Its guidance says plainly that administrative or operational errors inside a physician's office do not qualify, which rules out most backlogs.

The request goes on letterhead to [email protected] and has to carry:

• your full name, address, phone number and six-digit billing number, plus the four-digit group number where one applies;
• a list of the stale dated claims, each with the patient's health number, the fee schedule codes and the dates of service;
• the extenuating reasons that prevented submission inside the window, with supporting documentation where it exists;
• your signature, or a group representative's — the ministry does not accept a billing agent or secretary signature.

The useful work after discovering an aged-out batch is diagnostic rather than recoverable: find out what mechanism let those claims sit, and close it. Almost always the answer is that nobody was looking at the rejection queue, or that a category of encounter was never being entered at all.

Frequently asked questions

Sources

• Regulation 552 under the Health Insurance Act — the submission window.
• Ministry of Health — physician payment — payment runs and schedules.
• INFOBulletin 231001 — the three-month submission period and the stale dated claim routes.
• Education and Prevention Committee billing brief — what counts as extenuating circumstances.

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