How to Handle Non-OHIP Billing Claims

1. Out of province health coverage – this information is inclusive for all provinces and territories except Quebec: patients will have provincial health cards that are used to bill in the same software used to submit your OHIP billings. They will need to be submitted to the “RMB” program, indicating the applicable province/territory. These are submitted to MOH, who will in turn collect payments from the other provincial health ministries. Other ministries will pay out at MOH rates, and have the same time limit of 6 months from the date of service to submit claims. You can usually expect to receive payment in either the same billing cycle or the following one.
   
2. Quebec health coverage: patients will have Quebec health cards. Claims for services rendered to these patients must be sent to the Régie de l’assurance maladie, or RAMQ. Forms are available online and must be filled out in full. You have up to 12 months from the date of service to submit claims to RAMQ. You should be aware that the fees for physician services are lower in Quebec, and you will be paid at the lower rate. Also, payments from RAMQ take a fair bit of time to be processed, with payments typically arriving 4-5 months after you submit them.
   
3. WSIB claims: You must register with WSIB on their website and then fill in claims within the program. Claims should be filed within 6 months of the service date.
   
4. Interim Federal Health (refugee) or IFH claims: If you do hospital call shifts, you are likely going to see refugee patients under the IFH program, if you haven’t already. IFH is administered through MedAvie Blue Cross. Patients in the IFH program will have an 8-10 digit client ID number to bill under. You must also be registered as an IFH provider (MedAvie Blue Cross provides you with 6 digit provider number that must be used on all claims instead of your billing number). There are forms available online for IFH claims to be completed. IFH will pay out at MOH rates, and have the same time limit of 6 months from the date of service to submit claims. You can usually expect payment, by cheque or direct deposit, within 2-4 weeks after submitting claims.
   
5. Travel and international student coverage: There are several insurance companies that provide health insurance to travelers and/or international students; Blue Cross, UHIP (Sunlife Assurance) and Guard.me are some common examples. Each insurer will have their own forms available on their websites, which must be completed in full and submitted to them. Typically they will pay out at OHIP rates, however both the time limits for submitting claims and the time to expected payments will vary by company.
   
6. Patients without any health coverage:  When it comes to patients who don’t have any valid health coverage, you are able to invoice them directly and set your own rates for medical services rendered.