Here is a link to a video in our Help Portal: How To Simulate and Generate An OHIP File
Here are some steps to help guide you while creating claim files in OSCAR and submitting them to the MOH using the MCEDT Mailbox.
Billing Status:
Bill OHIP O: when an invoice is created, it will be in the status Bill OHIP (or Invoiced in the Invoice Reports). This status lets OSCAR know when I run my simulation to include the invoices and when I generate a claim file to pull this invoice status into the claim file to be sent.
Submitted OHIP B: once an invoice has been put into a claim file, it will change status to Submitted OHIP. It will remain in this status until the RA has been brought into OSCAR and settled.
Settled/Paid S: once the RA is brought into OSCAR and settled it will change status to Settled, so OSCAR knows when we are looking at the billing history, or invoice reports that this invoice was paid.
In order to create your claim file for OHIP, we're going to Simulate OHIP File and then Generate OHIP File.
Simulation OHIP File: run report 3 months back and look for any errors. If there are any errors, you can select the invoice number from the report and fix any flagged formatting issues. After opening the account number to address a flagged error - please ensure the Billing Status is still set to Bill OHIP. You may also select the status Do Not Bill, this will place the invoice on hold until the information can be fixed. The invoice can then be set to O Bill OHIP to be included in the simulation. You should not create a claim file that has received a Fail without correcting the errors. This will ensure that the claim file can be uploaded and that the MOH will be able to process it once received.
You will want to navigate to Administration and select the Billing tab:
From the Billing tab you will want to select Simulation OHIP File:
From here you will want to select a Provider, or All Providers. A date range would need to be entered, the To date will populate as Today's date, but that can be changed as well:
A simulation can be printed from the top right corner.
The patient chart can be accessed by clicking on their name from this report - this will load their Master Record.
The invoice will open with the Acct Number, also known as the Invoice Number.
The Simulation OHIP File is checking for formatting errors, not OHIP code/claim errors. It is checking and providing a PASS to indicate that the MOH would be able to process this generated claim file on their software without an error. If any invoices are rejected, that would be advised by the MOH on an Error Report.
Generate OHIP File: You will want to use the same date range and providers selected in the simulation when generating the report. Here the claim file will be created and that will change the statuses on the invoices from Bill OHIP to Submitted OHIP. It will then go into the upload queue of the MCEDT Mailbox.
After receiving your PASS on the Simulation OHIP File, you will want to select Generate OHIP File from the Billing tab:
From here you may now select a provider, or All Providers. The same date range entered in the Simulation can be entered since you know it Passed.
Please be aware that if you're billing under a group number, the group number will need to be selected from the Providers list. The individual provider's names will not be shown until a file is generated.
The generated claim file has now been moved to your upload queue of your MCEDT Mailbox for submission. Check out this link from the Help Portal on how to upload the claim file: How To Upload and Download Using the MCEDT Mailbox