How To Deal with Stale Dated Claims in OHIP

Submitting claims to the Ontario Health Insurance Plan (OHIP) is an essential part of running a medical practice in Ontario. However, sometimes claims can become stale dated, meaning they are submitted too late and are no longer eligible for payment. This can be frustrating for both patients and healthcare providers, but there are steps you can take to deal with stale dated claims.

Firstly, it’s essential to understand what constitutes a stale dated claim. According to OHIP, claims must now be submitted within 3 months of the date of service. After this time, the claim will become stale-dated and will no longer be eligible for payment. If a claim is rejected due to being stale dated, the physician will not receive payment, and the patient may be responsible for the cost of the service.

To avoid stale dated claims, it’s essential to submit claims in a timely manner. Many medical practices use electronic medical records (EMR) to manage patient information and submit claims electronically. This can be a more efficient and accurate way to manage claims, reducing the risk of stale dated claims.

However, if you do experience stale dated claims, there are steps you can take to manage them. It’s essential to review your billing practices and ensure that claims are being submitted in a timely manner.

If you are looking for a more efficient way to manage your billing and avoid stale dated claims, you may want to consider using a medical billing software system like YES Medical System; and reduce the risk of stale dated claims.

In summary, dealing with stale dated claims in OHIP can be frustrating, but by submitting claims in a timely manner and using the right tools, you can avoid this problem. If you’re interested in learning more about YES Medical System and how it can help you manage your billing and avoid stale dated claims, please contact them at 416-800-3770 or email

Ontario eHealth OLIS