There are 5 main sections to complete in order to create and submit your claims to the Ministry properly. They are as follows:
1) Completing the patient information section
Step 1: Select the patient you wish to bill for. This field acts as a search so if the patient already exists in your account, simply search for them by name or PHN. If the patient does not already exist, you can add them by clicking the “+” in the Patient Information box, completing the information, and clicking the blue Create Patient button (link to solution).
Step 2: Once the patient is selected, their information should prefill in the Patient Information section of the invoice.
Step 3: Add a Referral ID if the patient was referred to you by another physician. This field acts as a search so you can begin typing the referral physician’s name or practitioner ID. If they don’t appear in the search results, you can simply type in the practitioner ID if you know it, or you can add the provider as a custom referral provider by going to the Admin section in the left-hand side menu, opening the Referral Providers tab, and adding a new referral provider.
2) Completing the provider information section
If you’ve set a default provider* in your account (especially useful for sole practitioners), the Provider Information section should already be prefilled. Otherwise, simply begin typing the name of a physician or select them from the list that appears.
*To set a default provider, click the Edit pencil icon next to the Default Provider setting (found at the top right of the screen next to your account information) and select the provider’s name you wish to set as the default provider in the account.
To save, click the checkmark. Once this is saved, your new invoices will have the provider information section prefilled with this provider’s details.
3) Adding line items with appropriate service codes and diagnostic codes
All claims submitted to the Ministry will require a service code. Fee amounts may be modified using either the unit multiplier or, where applicable (especially in the case of surgical assists), can be overridden using the Fee field. Claims submitted to the Ministry also require a diagnostic code.
The service codes and diagnostic codes fields are searchable by code or by official description so typing numbers or letters in these fields will automatically display search results. Codes can be selected from the search results or typed in.
In order to complete a line item, follow these steps:
Step 1: input the appropriate service code. Service codes generally consist of 5 digits. You can search for a code by number or description. For longer descriptions, use your mouse to hover over the short descriptions displayed in order to see the full text.
Step 2: input the appropriate diagnostic code. You can search for the code by the number or the word.
Step 3: select the service date. By default, the service date is set to today’s date. In order to select a service date in the past, use the calendar feature.
Step 4: click the black “Add” button to add the line item to the invoice.
You can add as many line items as you’d like for a particular patient. They will be assessed based on the service code and service date.
4) Adding any additional information to the claim
Any other information that may be required in a claim, such as a claim note, different insurer type, and more can be set in the Advanced tab on the invoice creation page. This is where specific claim information, such as rural retention code or service location, can also be changed. This is especially important if the claim requires information that is different from what is saved in the default provider record.
British Columbia: Advance Invoice Creation
Alberta: Advanced Invoice Creation
Ontario: Advanced Invoice Creation
5) Saving and submitting your claims
Once you’ve completed all of the necessary information on your claim, you are ready to send it in! You can submit the claim immediately by clicking the green “Send Now” button at the bottom of the invoice, but we recommend saving the claim by clicking the blue “Save” button instead. Saving your claims will allow you to do one final review before sending them off in a larger batch.
To send off your batch of saved claims, go to the Manage Invoices section. The “New” status (first tab) will display your new, unsubmitted claims which you can then send in a batch by checking the top checkbox (next to Service Date). This will select all of the claims visible on the page and once you click the green “Send” button that appears after checking the items, they will be sent to the Ministry via the electronic submission system.
In order to send more claims than just the 10 visible by default, you can change the amount of items per page using the dropdown at the top of the screen.
You can also send just a few claims by selecting them using the checkboxes, or you can send claims individually by clicking the green arrow button at the end of each claim line.
Once claims have been sent, they will move into the Pending tab until they are assessed by the Ministry and sent back with updated statuses. You will not be able to edit claims that are pending until you receive a response from the Ministry on them.