Important changes are coming to the claims submission period for fee-for-services rendered in Ontario.

The Ministry of Health (the ministry) is adjusting the claims submission period for OHIP fee-for-service insured and related services from six months to three months from the date a service is rendered in Ontario, effective April 1, 2023.

This change is outlined in the 2021-24 Physician Services Agreement and the ministry is also implementing these claim submission timeframe adjustments for claim submissions from patients, other practitioners, community laboratories and independent health facilities.

This change will have no impact on claims for insured services rendered outside of the province of Ontario.

New “W3” Explanatory Code

Starting on the October 2022 Remittance Advice (RA), in order to assist providers during this transition, a new explanatory code ‘W3-Service date is older than 3 months’ will appear. This will alert providers that a claim was submitted more than three months from the service date.

The new explanatory code will assist providers for planning purposes by allowing the tracking of submission timelines well in advance of the effective date of this change. Claims that receive the “W3” explanatory code will still be processed for payment.

For more information please click on the link below.