New channel for eSubmission of Medical Claims supporting documentation and Remittance Advice Inquiries

To: OHIP Billing Software Vendors, Physicians, Primary Care Physicians, Hospitals, Independent Health Facilities, Hospital-based Dentists, Optometrists, Podiatrists, Physiotherapy Facilities, Fertility Clinics
Category: Billing Software Specifications, Physician Services, Primary Health Care Services, Independent Health Facilities, Dentist Services, Optometrist Services, Podiatrist Services, Physiotherapy Facilities, Fertility Clinics
Written by: Claims Services Branch; Health Programs and Delivery Division

Background

The Ministry of Health (ministry) has been working with providers and vendors to improve the efficiency of eSubmit services. Based on this feedback, effective January 31, 2023, eSubmit tickets can now also be created via Medical Claims Electronic Data Transfer (MCEDT).

As outlined in INFOBulletin #221201-eSubmit Service Delivery Enhancements, eSubmit is a secure electronic channel for health service providers to submit Remittance Advice Inquiries (RAIs) and medical claims supporting documentation (operative reports and clinical notes for manual review) which supports the adjudication of claims.

All authorized MCEDT users, including designees, automatically have access to the eSubmit service. Access eSubmit through GO Secure via ontario.ca/eSubmit.

eSubmit Integration with MCEDT file uploads

Effective January 31, 2023, Supporting Documentation and RAIs can be uploaded to eSubmit through MCEDT.

MCEDT web page (GO Secure login)

Users accessing MCEDT through GO Secure on their web browser will see a new option for “eSubmit Submission Upload” under File Type in MCEDT Uploads. Select this file type to submit Supporting Documentation or RAIs.

Designees will need to be granted MCEDT permissions for eSubmit Submission Upload to be able to upload the new file type.

The file naming convention must follow technical requirements to be properly processed. If the file naming convention is incorrect, then a response will be sent via MCEDT the following business day, advising on the type of error. Please see the document ‘eSubmit Technical Specifications for RAI and Supporting Documentation Electronic Submissions’ in the link below for details on the file naming convention.

eSubmit Integrated with billing software

Supporting documentation and RAIs can be submitted directly to MCEDT through your billing software. Please check with your software vendor to see if the eSubmit Submission Upload feature has been added as an option.

Successful Submission Confirmation

A confirmation response will be sent the following business day via MCEDT with the account number and eSubmit ticket number matching your submission.

Designees will need to be granted MCEDT permissions for eSubmit Submission Confirmation to download the confirmation reports.

eSubmit Technical Specifications for RAI and Supporting Documentation Electronic Submissions via MCEDT can be found on the ministry website.

Inquiries

Contact the Service Support Contact Centre (SSCC) at:1-800-262-6524 between 8:00 a.m. and 5:00 p.m., Monday to Friday (excluding holidays) for questions regarding eSubmit integration with MCEDT.

For any technical questions or issues, please contact your billing software vendor.

Keywords/tags

eSubmit; Remittance Advice Inquiry; RAI; Supporting Documentation

Contact Information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.