In February, the OMA and the Ministry of Health announced a tentative new Physician Services Agreement that covers the three years from April 1, 2021 to March 31, 2024.  There were a number of important aspects to the agreement, including physician compensation, a new model for virtual care, and new timelines for MOH submissions. 

This blog post is part of a series discussing different elements of this agreement, and the focus of the current article is on the changes to MOH submission timelines. 

For as long as JCL has been in this industry, doctors have had six months from the date of service to submit their claims to the MOH.  Beginning in April 2023, that time will shrink to three months.  A claim with a service date of April 1st, for example, will need to be submitted to the MOH by July 1st for the MOH to process for payment.  The MOH has indicated that this will bring Ontario into line with British Columbia, Alberta and Quebec. 

This has some important implications for doctors, especially those who are currently late in processing their billing.  While the vast majority of physicians submit their work regularly and typically within a month of the date of service, there are some who, for various reasons, are far behind.  These doctors have to be aware of the new timelines, and must make an effort over the next little while to develop better habits around submitting work promptly, so they get paid fully for the work they do. 

Currently, claims returned to physicians on an error report need to be fixed and resubmitted within the six months window, or they become stale.  In the new agreement, the OMA has negotiated that claims on an error report could be fixed and resubmitted after the three month window, and still be accepted.  But in reading the fine print, this process is going to be very labour intensive and many doctors who do their own billing will not want to get involved in it.  For example, if resubmission of an error report takes place after 3 months has passed, the agreement states, “the physician must provide supporting documentation to demonstrate that the original claim was submitted within the prescribed timeframe”.  The resubmitted claim also needs to be sent as a stale claim, and the original error report must be emailed to a designated email address.  All this is to say that if doctors want to make their life easier, they will send in their claims early enough that they have plenty of time to deal with errors.  Though rare, there could be certain reasons why a claim cannot be fixed within three-month window, so it is nice to know there is a way to deal with these claims that have become stale.  But, that should be seen as an absolute last resort.