Our physicians frequently have questions about how OHIP’s cut-off for claims submission works, and this blog post addresses that issue.

Back in the day of paper claims and diskette submissions, OHIP needed several days to run each physician’s diskette through their system. They had a submission deadline of the 18th of the month and any diskette received by that date was processed in time to be paid the following month.

Even today, with the vast majority of physicians set up for Electronic Data Transfer (EDT) – which is a much more efficient way of submitting and processing claims – OHIP’s posted cut-off is always the 18th of the month. However, OHIP will now process claims much later than the 18th. The issue for JCL is that we can never be sure exactly when the ‘real’ cut-off is going to be. We’ve seen it as late as the 30th of the month (meaning that all claims received by the 30th were actually paid on the next month’s RA) and it often seems to fall around the 25th or 26th. Remember, OHIP is not obligated to pay past the 18th, and we’ve seen them ‘flip the switch’ on the 22nd or 23rd as well.

We make sure all work sent to us by the 10th is submitted to OHIP by the 18th, but we do continue to send files past this date (as well as correct and resubmit any errors received). If a physician sends work to us regularly and sends us a file on the 20th, we can normally have that file off to OHIP by the 25th or so and it could very well get paid the next billing cycle, we just can’t be sure.

Because of this ‘floating cut-off date’, it’s possible for us to control the pay periods. Some physicians like to know that each OHIP deposit will cover about 4 weeks of work. They like to have a stable deposit each month. For these physicians, we can control when the work gets sent to OHIP so that their goal of stable cash flow is achieved. Other physicians, in contrast, want to get paid as quickly as possible and don’t mind if their monthly payments fluctuate.

Let us know what your goals are and we can come up with a submission schedule that fits those goals.