Why Didn't I Get Paid? The Submitted OHIP Invoice Status - ON

Here we will be going over how to conduct a Billing audit to determine why an invoice has not been updated to the Settled/Paid status.

This guide will help you review your Billings, and to determine if a whole claim file needs to be resubmitted to the MOH, or if an invoice may need to be resubmitted to the MOH.  

Though Support is happy to assist, or point you in the correct direction - please keep in mind that we're not a Billing service, therefore our support lies in the software.  After completing your Billing audit, should you need Support assistance in updating invoice statuses, or reversing a claim file back to the O Bill OHIP status for resubmission, we can happily assist.  Please note that requests regarding changing your Billings are required to be submitted to Support via an email - [e-mail]

The reason as to why an item has not been marked as Settled/Paid can vary for a number of reasons, below are a couple of examples.

Submission Date:

The date that the claim file was uploaded can determine if it will be processed for the current pay cycle, or the next. The MOH can guarantee processing of claim files by the 18th of each month, items submitted after this date may not be processed until the following month.  Though they tend to process items past this date, their dates that are posted each year is what they can confirm.  Here is a link to their 2025/2026 cut off dates: MOH Cut Off Dates For Submission

File Upload:

Though invoices may be created, and a claim file Generated - it still needs to be sent to the MOH for processing.  This can be done via the MCEDT Mailbox within OSCAR, of it can be done directly through the MOH's OPS BPS Secure site directly.  Here is a link to a video regarding how to upload with the MCEDT Mailbox: MCEDT Mailbox Uploads and Downloads The step of sending to the MOH is very important for them to be able to process it for a payment the following month. The MOH requires your password for OPS BPS Secure to be updated every 3-4 months, if the password has expired, then the claim file would be pending still in the upload queue.  There are errors that will display advising on password update.  Designation can also be a factor for uploading during this stage as well.  If a physician, or group number was recently added to the MCEDT Mailbox, then designation needs to be completed to the lead account in order to also upload with the MCEDT Mailbox.  Here is a link on designation: Designation Steps

Processed Claim File:

The MOH provides a Batch Acknowledgement (B File) for download, generally available anytime from 24-72 hours after a claim file has been uploaded.  This Batch Edit provides advisement that the MOH has received your claim file, and that they were able to process it.  If the MOH was unable to process the claim file received, they would advise that within the Batch Edit.  Here is a link to a video: Reviewing Batch Acknowledgement It is important to review the Batch Edit for each submission.

Error Reports and Rejections: 

In addition to the Batch Edit, if any invoices are rejected, they would be on an Error Report with an error code advising on what needs to be corrected.  Here is a link to a list of codes from the MOH: Error Report Rejection Codes Invoices that have been rejected need to be corrected and resubmitted in a timely manner to be processed on the current pay.

Explanatory Errors On The RA:

During the RA processing on OSCAR, only paid items that have received an Explanatory Error will be marked as Settled/Paid with the S35 button.  Examples of paid Explanatory Errors would be 35, 33, 55, 57 and EV, some 30 and some I9 may as well be marked as Settled.  Invoices that have received a partial payment, or no payment will remain in the B Submitted OHIP status, such as M1.  This is designed so that those invoices can be reviewed in an Invoice Report to be determined at clinic level if they will be marked as Settled/Paid manually, or if the clinic/physician is opening an investigation with the MOH by completing a Remittance Advice Inquiry (RAI) on the MOH's OPS BPS Secure site under their eSubmit service.

Now that we have determined a few different reasons as to why a claim file, or an invoice has not been updated to Settled/Paid status yet, we will go over the process together.

Invoice Status:

O Bill OHIP - newly created invoices, or recently corrected invoices ready for submission to the MOH.

B Submitted OHIP - invoices that have been included in a generated claim file, but have not been marked as Settled/Paid yet.

Settled/Paid - items that have been marked as Settled/Paid after processing the RA file.

Once ready to submit to the MOH, a Simulation OHIP File should be run to aid in capturing any formatting issues.  This Simulation is checking for problems that may arise while processing the claim file on the MOH's software.  It is not checking for OHIP errors, but ensuring that when the MOH receives your claim file, that they can process it without error.  Here is a link on Simulating and Generating a claim file: Simulate and Generate OHIP Claim File It is recommended to address any Failed invoices, and to not move to next stage until a Pass was received during Simulation OHIP File.

While running my Simulation OHIP File, I received an error message of:

I couldn't locate invoice 96 in the Simulation, so I moved on to the next stage.

Next, Generate OHIP File - during this stage, a claim file is generated for submission.  It is important to enter in the same date range as the Simulation OHIP File, because it Passed.  By leaving the Start Date empty, you may potentially include a bad invoice.

I generated claim file HE456789.001.

Next, MCEDT Mailbox for uploading the claim file.  The generating step is not submitting the invoices to the MOH, the claim file still needs to be sent to them.  Please ensure that the password entered in the MCEDT Mailbox is current, if you receive a password error, then it must be updated for the claim file to be uploaded.  Here is a link regarding updating this information: Password Update

I uploaded this generated claim file for the MOH through the MCEDT Mailbox.

From the MCEDT Mailbox, there is a Sent folder that can be reviewed to see if the claim file has been sent. When the files have been upload the Upload queue should be empty.  This can be viewed by clicking on Upload in Black along the top of the MCEDT Mailbox:

From the Sent folder, you can check the status of WIP, which stands for Work In Progress.  This is the final status of the claim file that we can update, as once in this status it is on the MOH software. Here is a link regarding the Sent folder: Sent Folder MCEDT Mailbox

The only real confirmation is the Batch Acknowledgement report that would be included in your Downloaded reports.  

I don't tend to review the Batch Edit files, and just move them to the Archive folder once downloaded. 

Error Reports need to be downloaded, and any invoices that have been rejected would need to be corrected and set back for re-submission.  Here is a link on corrections: Corrections

There is also the option of completing corrections using the Invoice Report tool for Rejected Invoices: Rejected Invoice Reports

I never received an Error Report for my claim file, so I would assume that everything has been processed for the next payment.

The RA is available at the start of each month to advise on payment to be received mid-month.  This report can be processed within the EMR once available, this will update the invoice status to Settled/Paid, which allows for Invoice Reports to run and showcase unpaid invoices.  Here is a link on how to process the RA file: Processing Remittance Advice - RA

I noticed that the Paid amount is lower than expected, and I am unsure as to why that may be, as everything was submitted.  I'm going to run some reports now to review.

Invoice Reports is a handy tool that allows you to run Billing Reports based on the invoice status within OSCAR.  This allows you to be able to track unpaid invoices, as well as paid items.  Here is a link on how to run Invoice Reports for Settled/Paid: Settled/Paid and then for Submitted OHIP: Submitted OHIP

While running the Submitted OHIP Invoice Report, I can see that I have a number of invoices still marked as Submitted OHIP, and they do not have any error codes on them.  Why are they not Paid?

Before contacting Support, please take the time to complete a Billing audit to determine why it has not been Paid, and to determine if you need Support assistance in this matter.

From the Invoice Report, or from the Billing Corrections page with an invoice open, you can click on the History tab in the top right corner to view invoice details:

Now we can check the Billing Status to see what claim file it was included, and the date:

We can see in our example, that invoice 96 was included in claim file HE456789.001 on May 14th, 2025.  

If there are multiple invoices in the Submitted OHIP status, they may have all be included in the same claim file, so this step will help narrow down what claim files and date needs further investigating.

Now, that we have a claim file name and a date, we can check the MCEDT Mailbox if it is in the Upload queue, and if it is in the WIP status of the Sent folder:

Since it shows as being uploaded to the MOH, and that they received it on their end - why was it not Paid?

We will need to find the downloaded Batch Acknowledgment for confirmation. From View MOH Files, we can scroll to the date, and review any of the Batch Edits to locate one that has the Creation Date of May 14th, 2025 the same as the Generated claim date.

With the B file located, BE00123.123 we can see from the message under Rejection Reason that the MOH was unable to process the claim file: 

This doesn't make sense, we always run a Simulation OHIP File, how did this happen?

From Generate OHIP File, we can click on the HTML link to the far right of the claim file to view its contents:

If it passed Simulation OHIP File, it would show with a Green bar at the end.  If it had failed the Simulation OHIP File, it will show with an Orange bar at the end, and may also have an invoice high lighted in Yellow with a failed message:

Invoice 96 caused an issue in the submission, this invoice prevented the MOH from being able to process the contents of the claim file.  

I will need to contact support at [e-mail] and request that the claim file HE456789.001 be placed back in O Bill OHIP status.  I will also inquire into the message "Should be marked as Delete" to ensure this does not happen on the next submission.

If an invoice receives the Should be marked as Deleted message, it most likely does not contain any service codes, but it is still in the O Bill OHIP status.  If an invoice is made in error and you need to Delete it, the status can be updated to Deleted Bill:

Removing the service codes will not delete the bill, only remove the service codes.

In this scenario, Support would be able to assist in resetting the claim file so that a new file can be generated for submission.

The steps above can aid in determining why an invoice, or a claim file has not been updated to Settled/Paid.  It is important to review your Billing reports from the MOH in a timely manner so that you can address any discrepancies or issues encountered.

Prior to contacting Support for assistance, please ensure that you've completed a Billing audit.

If contacting Support for assistance please advise on Invoice Number(s), and Generated Claim File names (H File), and if required the Batch Edit file name.

 The above scenario requires Support assistance in resetting the claim file, other reasons mentioned at the start may not require Support assistance.

• If the claim file was uploaded past the MOH cut off date, and a Batch Edit was received, then the contents may not be processed until the next RA.  You can always contact a MOH representative for this confirmation, 1800-262-6524.
• If the OPS BPS Secure password has expired and you receive error when uploading, you can update it first on MOH site and then within the MCEDT Mailbox to match.  Once the password is updated in both locations, the claim file can be uploaded.
• If there is a permissions error for a billing number when uploading from the MCEDT Mailbox, this implies that the whole designation process has not been completed.  There are 3 main steps of the designation process, please review link provided above to ensure the designation is completed.  Once designation is done on the MOH's OPS BPS Secure site, the claim file could be uploaded from the MCEDT Mailbox.  If designation is not completed until after the MOH cut off, then it would be processed for next RA.
• If an invoice was rejected on an Error Report, it would need to be corrected and resubmitted.  If it was not corrected until after the cut off date, then it would not be processed until the next RA.
• If it was on an RA, but received an Explanatory Error, you could complete a RAI on the MOH's OPS BPS Secure site under eSubmit, or you can manually update the status to Settled/Paid.

Please reach out to Support if you need any Billing assistance with the software.

If you have more in-depth billing inquires, please contact a MOH representative directly, or you may contact a Billing agency, such as DoctorCare [e-mail]