OHIP billing for Ontario Canada

Management and Administration
#1

nexus77 wrote on Wednesday, January 11, 2017:

Hi, just wondering if it is possible to use OpenEmr to bill Ontario’s OHIP system here in Canada.
Thanks in advance

#2

bradymiller wrote on Thursday, January 12, 2017:

Hi Vince,
What coding does OHIP use?(coding in OpenEMR is very customizable)
Regarding actual insurance billing, this is currently very US centric, so guessing would require development.
-brady
OpenEMR

#3

nexus77 wrote on Wednesday, January 18, 2017:

Hi Brady,
Thanks for the reply! To be honest, I have no idea what coding OHIP uses but will try to find out.
Thanks again

#4

Hello

I came upon this thread looking to see if there are any instructions on setting up OHIP billing for Ontario Canada for OpenEMR.

Here are the billing codes in use in Ontario. How do I add these to OpenEMR and submit billing directly to the insurer (OHIP)?

http://www.health.gov.on.ca/en/pro/programs/ohip/sob/

Thank you

#5

hi @erythrocyte, there’s some existing code that makes it easy to bring in new codes for billing but do you know of any specs on how to format the billing files for submission to OHIP?

#6

I suspect that this information is available here in the extensive documentation

http://www.health.gov.on.ca/en/pro/publications/ohip/mcedt_mn.aspx

#7

would take some work to build this according to http://www.health.gov.on.ca/en/pro/publications/ohip/docs/techspec_interface_hcsm.pdf

#8

Hi Stephen

It would be great to have OpenEMR work at a level playing field with OSCAR the other open source competitor in Canada so folks have options to choose from.

OSCAR’s wiki has a ton of useful information too that maybe useful to OpenEMRs development team.

http://oscarmanual.org/15/developers/installation/mcedt

http://oscarmanual.org/oscar_emr_12/General%20Operation/billing

What I’m looking for is an open source EMR that allows for work at both US and Canadian sites (for an institution or clinic that has clients in both countries) under one umbrella, using one database that allows for easy migration (data import/export) between open source EMRs. The data being stored according to agreed opensource format specifications with the EHR itself using a common specification to link with the database (like DBI in Perl).

It appears that there is a company listed as a Canadian IT support group for OpenEMR on the wiki

It may be a good start to add OHIP functionality as a module to OpenEMR by communication with them.

Adding Canadian billing code and sales tax functionality for uninsured services may be a relatively easy thing compared to the US billing codes which are way more complicated.

Thank you

#9

It is also a good idea to get in touch with OntarioMD or the equivalent organisations in other provinces (eg. Doctors Technology Office in BC). There are financial incentives to physicians in some provinces to use a certified EMR in their province. In Ontario apparently upto 2015 physicians got additional funding to adopt certified EMR in their practice.

https://www.ontariomd.ca/emr-certification/overview

Additionally the licensing body in each province has guidelines about core functionality and use of EMR that is expected as standard. These are usually common between various US and Canadian jurisdictions

https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Medical-Records

#10

I have a partially built OpenEMR with some OHIP changes,
OHIP Lab form, missing billing for OHIP, and Comms to OHIP labs and other things.
I need a funding MD office who is willing to invest in development.

gc

1 Like
#11

Any progress here ?
I need OHIP labs :slight_smile:
I’m just trying OEMR for the first time right now.

#14

Any updates?
I want to organize the funding to setup OHIP billing in OpenEMR so it can generate the claim files. There are several interested parties.

OHIP billing is 5x simpler than the American billing system and codes; there is one txt file which contains the service code definitions (each is 5 characters for example A007A); when you make a bill, you just enter the right service code and ICD9 diagnostic code, adjust quantity if necessary. When ready to submit the billings to OHIP, EMR is just supposed to pull the bills that haven’t been submitted before, and generate a text file with the proper formatting (health insurance identifier, date of birth, billing code, physician’s billing number).