A complete guide for Ontario physicians, from the company that has billed OHIP and nothing else since 2016 — now for more than 2,000 physicians across the province.
OHIP (Ontario Health Insurance Plan) billing is the process by which physicians submit claims to the Ontario government for insured medical services provided to patients. When a physician sees a patient with a valid Ontario health card, they bill OHIP for the service using specific billing codes.
The billing process involves submitting claim data electronically to the Ministry of Health, including patient information, service codes, diagnostic codes, and dates of service. Claims are processed and physicians receive payment through the Medical Claims Electronic Data Transfer (MC EDT) system.
You do not have to run any of this yourself. IntelAGENT does the whole cycle for Ontario physicians — the submission, the reconciliation and the rejections — for 0.25% of paid claims capped at $39.99 a month, or 2% with a dedicated billing agent who handles it all for you.
Fee codes are specific alphanumeric codes that identify the medical service provided. Each service has a designated fee code and associated payment amount set by the Schedule of Benefits. For example, A001A represents a minor assessment, while A003A represents a general assessment. Physicians must select the appropriate fee code that accurately reflects the service rendered.
Diagnostic codes (ICD-9 codes) indicate the medical reason for the patient visit. These three-digit codes describe the condition being treated or assessed. Accurate diagnostic coding is essential for claim approval and helps the Ministry track healthcare utilization patterns across the province.
Before billing OHIP, physicians must verify patient eligibility through their Ontario health card. The health card contains a 10-digit health number and version code. Validating this information ensures the patient is covered under OHIP and reduces claim rejections due to eligibility issues.
The Remittance Advice is a report from the Ministry of Health showing the status of submitted claims. It details which claims were paid, rejected, or require additional information. Understanding and reconciling your RA is crucial for maintaining accurate billing records and addressing rejected claims promptly.
Every one of these is caught before submission in IntelAGENT, or worked for you by your billing agent after the fact:
Manual OHIP billing is slow and easy to get wrong. Ten years of building nothing else has gone into making this part disappear.
Join 2,000+ Ontario physicians who trust IntelAGENT for faster, easier billing.