Ontario Health Insurance Plan

Resources for Physicians

On this page you will find learning materials that will help physicians bill OHIP.

This information requires knowledgeable interpretation. It is intended primarily for members of the professional health care community.

Physicians are responsible for understanding and complying with payment requirements for any and all claims submitted to OHIP using their billing number.

OHIP Registration and Billing Number Maintenance

Payment and Schedule of Benefits

Guidance on Specific Billing Matters

Payment Accountability

Electronic Business Services

Submission of Claims

Patient Eligibility and Health Cards

Note

Claims for payment submitted to the Ontario Health Insurance Plan (OHIP) must comply with the legislative requirements of the Health Insurance Act and its regulations, including the Schedule of Benefits for Physician Services. The ministry ensures compliance with these requirements to claims for payment on behalf of the General Manager of OHIP.

To ensure prompt payment, submitted claims are paid on an honour system after being processed through computerized checks.  These initial checks and resulting payment do not mean that all requirements have been met.

The ministry may review paid claims. Should the ministry determine that claims were paid that did not meet requirements (i.e. a circumstance in section 18 (6) of the Health Insurance Act exists), the ministry may seek reimbursement by requesting a hearing of the Health Services Appeal and Review Board (HSARB) to review the payments.

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

 
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