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Ministry Status: Routine Monitoring and Engagement

Ontario Health Insurance Plan

OHIP Bulletins

Interprovincial Health Care InfoBulletins

To:  Hospital

Published by:   Health Services Branch

Date Issued:  June 24, 2016

Bulletin Number:  NA72

Re:   Time limit for submission of reciprocal hospital claims denied by the Workplace Safety and Insurance Board (WSIB) and/or Worker's Compensation Board (WCB)

The Interprovincial Health Insurance Agreements Coordinating Committee has provided the Ministry of Health and Long-Term Care with their policy on the time limit for submission of a reciprocal claim for an out-of-province patient where the claim was originally submitted to WSIB/WCB and subsequently denied.

Effective immediately, hospitals have 12 months from the date of the written denial notification from WSIB/WCB to submit a claim for an out-of-province patient through reciprocal hospital billing.

If the claim is not submitted within 12 months of the date of the denial letter, the hospital must absorb the cost of the service and cannot charge the patient.

A copy of the WSIB/WCB denial letter must be submitted along with the claim if the service date is more than 12 months in the past. Keep the original denial letter in your records.

Please share this information with your interprovincial billing department.

Note: As always, view and record (in your records) the details on the out-of-province patient’s health card.

For inquiries related to this matter, please email: InterprovincialBilling.MOH@ontario.ca

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