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Ministry Status: Routine Monitoring and Engagement

Ontario Health Insurance Plan

OHIP Bulletins


Keeping Health Care Providers informed of payment, policy or program changes

Fertility Clinics InfoBulletins

To:  All Health Care Providers

Published by:  Health Services Branch

Date Issued: July 6, 2017

Bulletin Number:  12011

Re: Reminders regarding Administration of the Ontario Fertility Program (OFP)

Posted Electronically Only

PDF Version Portable Document Format | 1 Mb | 

As the Ontario Fertility Program (OFP) has completed its first full funding year, this bulletin provides some important reminders regarding administrative requirements under the program.

  1. Submitting Remittance Advice Inquiries (RAIs)

In order to make an adjustment or correction to an OFP claim (fee code B600A-B607A), the fertility clinic that submitted the original claim must submit a Remittance Advice Inquiry (RAI).

The ministry’s RAI form can be found at:
http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/GetFileAttach/014-0918- 84~1/$File/0918-84E.pdf.

  • Please ensure that submitted RAIs are completed thoroughly. This includes indicating the reason for the adjustment or correction.
  • Submit completed RAI to your local OHIP claims office for processing.

In cases where a B600A-B607A fee code must be removed (such as when a claim was submitted in error or when a patient is transferring clinics and the eligibility check must be reversed), indicate on your RAI that the claim needs to be “DELETED”, not “negated.

Examples of Common RAI Submission Scenarios:

Example 1:

Patient eligibility for the OFP has been confirmed, but patient has not yet begun receiving funded services and patient is now seeking to transfer to another clinic.

A patient has been registered at Clinic A via the submission of an OFP eligibility code (either B602A for funded IVF services or B605A for funded FP services), but Clinic A has not yet started delivering funded services to the patient. Now, the patient wishes to transfer to Clinic B to receive funded services there instead.

Patients can move between clinics before any funded IVF services have been rendered.

To correct this situation:

  • Clinic A must submit an RAI to DELETE the eligibility code including the reason for the deletion.
  • Once the RAI is processed, Clinic B can re-submit the eligibility code.

NOTE: If Clinic A incorrectly submits the RAI to “NEGATE” the eligibility code, the code is paid at $0 but will remain on the patient’s claim history and prevent Clinic B from re-submitting a new eligibility code.

Example 2:

Patient has received a fresh embryo transfer under the OFP and excess embryos are frozen but the patient is now seeking to transfer to another clinic for the frozen embryo transfers.

A patient has been registered at Clinic A via the submission of an IVF eligibility code (B602A) and has achieved IVF Payment Milestone 1 at Clinic A (B603A has been billed). The patient now wishes to seek a funded Frozen Embryo Transfer (FET) at another clinic, Clinic B.

Patients can move between clinics after fresh embryo transfer (IVF Payment Milestone 1) and before any frozen embryo transfer(s) are performed.

To correct this situation:

  • The patient, or Clinic B on the patient’s behalf, will need to make arrangements with Clinic A for Clinic A to submit a RAI to DELETE the B602A eligibility claim including the reason for the deletion. (This will not impact the payment of the B603A to Clinic A.)
  • Once the RAI is processed, Clinic B will re-submit the B602A claim for that patient.
  • Clinic B can begin providing the funded FET services.
  • Once IVF Payment Milestone 2 has been achieved, Clinic B can submit the B604A fee code.
ExampleE 3:

The OFP has been billed in error for an intra-uterine insemination (IUI) cycle that was privately paid.

A patient privately pays for an IUI cycle; however Clinic A accidentally submits the B600A fee code for a funded Complete IUI cycle and receives payment.

To correct this situation:

  • Clinic A must submit an RAI requesting to DELETE the claim including the reason for the deletion. This will ensure that this claim is removed from the patient’s claim history and payment is reversed.

NOTE: An RAI to adjust or delete a previously submitted claim must be submitted by the clinic that submitted the claim originally.

  1. Claims Submission - Stale-Date Reminder

All claims, including resubmitted claims and RAIs, must be submitted within three months of the service date. Claims submitted more than three months past the service date are considered stale-dated and are not payable by the OFP and cannot be charged to the patient.

Each claim submitted to the OFP contains a “service date”, which can be:

  • The date that the claim is submitted for the Eligibility Check for Funded IVF Cycle or FP Cycle;
  • The date that the last Funded IUI Service was rendered as part of the Complete IUI Cycle or Incomplete IUI Cycle;
  • The date that the last Funded IVF Service was rendered to achieve a IVF Payment Milestone 1 or IVF Payment Milestone 2 for Funded IVF Services;
  • The date that the last Funded FP Service was rendered as part of the Funded Oocyte FP Cycle or Funded Sperm FP Cycle for Funded FP Services.
  1. Notifying the ministry of Clinic Changes

Clinics are required to notify the OFP immediately of changes that will impact the Agreement. The ministry will advise the fertility clinic of any additional requirements to finalize the change.

This includes changes to:

  • Legal name or operating-as name;
  • Authorizing person;
  • Contact person; and
  • Address where notice should be provided (mailing address).

Please notify the OFP if your clinic undergoes any of these changes listed above by emailing fertilityprogram@ontario.ca, or by mailing to:
Ministry of Health and Long-Term Care 1055 Princess Street, 2nd Floor
PO Box 168, Stn Main Kingston ON  K7L 5V1

  1. Directing Patient Inquiries

The ministry encourages the public/patients to speak with their clinic/physician for clarification on the OFP.
Alternatively, patient inquiries related to the OFP may be directed to ServiceOntario, using the following contact information:

ServiceOntario INFOline:
In Toronto 416-314-5518
Toll Free 1-866-532-3161

Please note that the OFP’s email address fertilityprogram@ontario.ca is only for participating clinics/physicians and is not intended for use by the public/patients.

  1. Communication Requirements – Advertising

 Fertility clinics participating in the OFP are required to adhere to the Communication Requirements specified in Articles 7.1 & 7.2 of the Transfer Payment Agreement when creating their own communication materials.
Fertility clinics choosing to distribute their own OFP-related publications, whether written, oral, or visual, are required to:

  • Acknowledge the support of the province and ministry through the OFP funding; and
  • Indicate that the views expressed in the publication are the views of the fertility clinic and do not necessarily reflect those of the province, ministry, or OFP.

These requirements apply to any OFP-related communication issued by a participating clinic, including traditional advertising (print, radio, television, etc.) as well as anything posted on social media (e.g., Facebook, Twitter, etc.).

Please direct any questions regarding OFP policy to fertilityprogram@ontario.ca.

To view Portable Document Format PDF files, you will need to have Adobe Acrobat® Reader installed on your computer. You can download this free software from the Adobe website.

For More Information

Call ServiceOntario, Infoline at:
1-866-532-3161 (Toll-free)
In Toronto, (416) 314-5518
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282
Hours of operation: Monday to Friday, 8:30am - 5:00pm