How to Handle Non-OHIP Billing Claims

Patients from other Canadian provinces or territories will present their provincial health cards. These claims are billed through the same software used for OHIP submissions and should be submitted under the Reciprocal Medical Billing (RMB) program, selecting the applicable province or territory.

Claims are submitted to the Ontario Ministry of Health (MOH), which then collects payment from the patient’s home province or territory. Payment is issued at Ontario MOH rates.

• Submission deadline: Within 3 months of the date of service 
• Expected payment timeline: Usually within the same billing cycle or the following cycle 

Patients insured through Quebec will present a Quebec health card. Claims for these patients must be submitted directly to the Régie de l’assurance maladie du Québec (RAMQ) using the required forms available online.

Please note:

• RAMQ reimburses physician services at Quebec fee schedule rates, which are generally lower than Ontario rates 
• Forms must be completed in full 
• Submission deadline: Within 3 months of the date of service 
• Expected payment timeline: Approximately 2-6 months after claim submission

To submit Workplace Safety and Insurance Board (WSIB) claims, physicians must first register with WSIB through their website. Claims are then submitted within the WSIB portal.

• Submission deadline: Within 3 months of the date of service 

Physicians providing hospital call coverage may encounter patients insured under the Interim Federal Health (IFH) program. IFH is administered by Medavie Blue Cross.

Patients covered under IFH will have an 8–10 digit client ID number. Physicians must also register as IFH providers and will receive a 6-digit provider number, which must be used on all claims instead of the physician billing number.

Claim forms are available online and must be completed in full.

• IFH reimburses at Ontario MOH rates 
• Payment may be issued by cheque or direct deposit 
• Submission deadline: Within 6 months of the date of service 
• Expected payment timeline: Approximately 2–4 weeks after submission 

Several insurers provide health coverage for travelers and international students, including:

• Blue Cross 
• Sun Life (UHIP) 
• Guard.me 

Each insurer has its own claim forms and submission requirements. Claims must be completed fully and submitted directly to the insurer.

• Reimbursement is typically based on OHIP-equivalent rates 
• Submission deadlines and payment timelines vary by insurer 

For patients without valid health insurance coverage, physicians may bill patients directly and set their own fees for services rendered.