NEW FOR ONTARIO DOCTORS
Direct, real-time access to drug information through your EMR
From within your electronic medical records, clinicians can easily obtain patient medication information from Ontario’s Digital Health Drug Repository (DHDR).
QUESTIONS & ANSWERS
- What is the billing cut-off date for OHIP?
- Does OHIP Have An App?
- How Often Should You Submit OHIP Claims? The Answer Might Surprise You
- Free OHIP Billing Software: Why It’s Not Always the Best Choice
- What is a VJ7 / VJ8 error code – Stale Dated Claim?
- How do I submit my billing to OHIP?
- How Does OHIP Billing Work?
URGENT NOTICE REGARDING OHIP FEE UPDATES – DO YOU HAVE THE CORRECT UPDATE?
As a medical practitioner in Ontario, you rely on timely and accurate payment for the services you provide to patients. However, maybe your OHIP vendor has not provided you with updated fee schedules for OHIP billing? This lack of attention to detail could have serious consequences for your practice and your patients.
Ontario Health Insurance Plan bulletins for Physician services.
Links to Ministry of Health and Long-Term Care OHIP Bulletins for Medical Professionals in Ontario.
2023
- New payment rules are being applied to Fee Schedule Codes K189A, E514A, E644A, E880A, and E949A
- K189A – Urgent community psychiatric follow-up
- E514A – Post mastectomy breast reconstruction – immediate breast reconstruction following mastectomy
- E644A – Radical mediastinal node dissection following preoperative chemotherapy and/or radiotherapy
- E880A – Thyroidectomy – parathyroid(s) re-implantation
- E949A – For adjustable suture (to Strabismus Procedures)
- Update: Claim Submission Timeframe for In-Province Accounts
- Year 3 Increase: Toronto Palliative Care Associates
- Year 3 Increase: St. Joseph’s Health Centre
- Year 3 Increase: Homeless Shelter Agreements
- Year 3 Increase: GP Focused Practice — Palliative Care
- Year 3 Increase: GP Focused Practice — HIV
- Year 3 Increase: GP Focused Practice — Care of the Elderly
- The temporary 2.01% global increase to physician payments will be replaced with targeted fee code adjustments
- Certain temporary COVID-19 physician services funding ends on March 31, 2023
- Temporary physician fee codes for COVID-19 Assessment Centres and after-hours premiums will be extended
2022
- Ontario Virtual Care Program: Video Visit Payment Option Ending (December 1, 2022; payments will transition to the OHIP Insured Framework)
- Update: Expired Photo Health Cards and Red and White Health Cards
- New Virtual Care Funding Framework
- Hospital Technical Fee Medical Claims Adjustment (MADJ)
- Claims Submission Timeframe for In-Province Accounts (changing the claims submission period for in-province accounts from six months to three months)
- Rowan’s Law Initiative: Concussion Safety
- Extension of Temporary COVID-19 Physician Services (OHIP physician services funding is being extended until March 31, 2023)
- Implementation of the New Virtual Care Funding Framework
- Weekend Access for Family Health Organization (FHO) Patients
- Updates Underserviced Area Program and Specialized Models
- Updates Rural and Northern Physicians (Increases to Rural and Northern Physician Group Agreement)
- Payment of Q007A COVID-19 Vaccine Patient Facilitation Fee
- COVID-19 Antiviral Treatments
- Temporary increases for primary health care services
- Temporary increases for physician services payments
- 2022-2023 Community Access Pilot for Laboratory Services
- COVID-19 Vaccine Extension and Ending of Q007A
- Hospitalist & Focused Practice Psychotherapy Premium Changes
- 2021–2022 Northern Physician Retention Initiative
2021
- Restoration of Hard Cap Threshold Limits
- Virtual Urgent Care Centres and Primary Care Outside Use
- Virtual Care Services and Outside Use/Access Bonus
- Virtual Care Services Require Modality Indicators
- COVID-19 Advance Payment Program Recoveries
- 2020-2021 Northern Physician Retention Initiative
2020
- Medical Claims Adjustment for S207A, G496A and K181A
- System solution for E405A effective December 1, 2020
- Mailing and fee changes for K065 and K066 fee schedule codes
- Temporary Payment Criteria for After Hours Procedure Premiums
- Expired and Expiring Health Cards During COVID-19
- Release 5 Changes and K229A Eligibility Incident Resolution
- COVID-19 Hospital Physician Compensation: E405A Changes
- Medical Claims Adjustment for E386A and E683A Fee Increases
- COVID-19 Virtual Care K-Codes and Management Fee Equivalents
- New Temporary Virtual Care K-Code K084A
- Equivalent Payments for Selected Premiums and Management Fees related to the Temporary COVID-19 Virtual Care K-Codes
- Medical Liability Protection (MLP) Quarterly Reimbursement
- COVID-19 Temporary Fee Schedule Codes Implemented-Physicians can begin to submit claims for COVID-19 on May 1, 2020
- Medical Claims Adjustment—Arthroscopic Knee Surgery
- Virtual Care Program – New Virtual Care Billing Codes Effective
- COVID-19 Expanding access to OHIP Coverage and Funding Physician and Hospital Services for Uninsured Patients
- Program Changes in response to Corona Virus (COVID-19)
- Changes to the Schedule of Benefits for Physician Services (Schedule) in response to COVID-19 influenza pandemic
2019
- Claim Adjustments – New Explanatory Codes
- ColonCancerCheck (CCC) Program-Fecal Immunochemical Test (FIT)
2018
2017
- Echocardiogram Payment Eligibility and Accreditation
- A3H and New Error Code A3I – Number of Services Exceeds Maximum Services
- OHIP+ and Medications for Children and Youth
- New Ministry of Community and Social Services (MCSS) Fee Schedule Codes – Appendix F
- Tuberculosis (TB) skin test
- Payment of 2016 Seasonal Premium – EDAFA
2016
- Reminder regarding delisting of high-strength long-acting opioids under the Ontario Drug Benefit program
- OHIP Claims for Fertility Services and the Ontario Fertility Program
- Nurse Pratitioners: Referrals and Delegated Procedures
- Submission of out-of-province (OOP) medical claims denied by the WSIB and-or the WCB
- Publicly Funded Community Based Physiotherapy Program and Eligibility Criteria
- Accreditation Requirement for Echocardiogram Services
2015
- Implementation of 2.65% Physician Payment Reduction – OHIP Schedule of Benefits 2015
- Q&A – Implementation of 2.65% Physician Payment Reduction
- Automation of Reciprocal Medical Billing Claim Submissions for patients from the Outaouais Region of Quebec
- New Referral Process for Bariatric Programs
- Changes to Primary Health Care Physician Payments
- Guidelines for Physiotherapy Service Encounter Submissions
2014
- Electronic Data Transfer Decommissioning December 2014 Recipients
- Periodic Oculo-Visual Assessments (POVAs) for Social Assistance Recipients
- Follow-up to INFOBulletin 4627 – IHF Licence Application Process for Grandparented Services
- New Error Code and Explanatory Code
- New Ontario Laboratories Information System (OLIS)
Withdrawal and Reinstatement of Consent Forms - Physician On-Call (POC) 2013-14 Payment Adjustments (PDF)
- New Ontario Photo Health Card (PDF)
2013
- Changes to Publicly Funded Physiotherapy (PDF)
– Questions and Answers (PDF) - Implementation of 2012 Physician Services Agreement – Amendments to the Schedule of Benefits for Physician Services Effective April 1, 2013 (PDF)
- Implementation of 2012 Physician Services Agreement – Amendments to the Schedule of Benefits for Physician Services – Effective January 1, 2013 (PDF)
- Laboratory Test Utilization Management Changes to the Schedule of Benefits – Laboratory Services (PDF)
- Updated Approval Guidelines for Gamma Knife Radiosurgery (PDF)
- April 1, 2012 Amendments to the Schedule of Benefits for Physician Services (PDF)
- To read more about the Ministry of Health and Long-Term Care Bulletins,click here.
January 20, 2014 – Exemption Criteria for Enhanced After-Hours Requirement (PDF)