When you use CabMD do to your billing, CabMD sends claims to the Ministry of Health (MOH) on your behalf. What happens after that?
This article will give you a brief timeline of how your claims get processed and paid by the MOH.
Step 1: After you have finished and saved your claim in CabMD, you then go under your unsubmitted section and submit the claim to the MOH. When this is done, the input file that contains your claims will be sent to our automated system and will then connect to the MOH server for you. When CabMD connects to the MOH server, your input file will be uploaded and any return files (Error or Batch files) will be downloaded from the MOH and added to your account.
Step 2: The claim is then processed by the MOH. If there is an issue with the claim, the MOH will issue an Error file about the claim. When CabMD received this file, it will move the associated Claim in CabMD into the Rejected section. You can then go in to the Rejected section and look at the error, and edit the claim (Pencil Icon to the left of the claim). Once you have finished correcting the error, you can then Save and re-submit the claim to the MOH again.
If there are no errors in the claim, the MOH will then send the claim back in a Batch file saying the claim has been processed and awaiting payment.
Step 3: After the claim submission cut off date (Link to the cut off dates can be found HERE) the MOH will process all of the claims and the ones that are correct and processed, will be issued in the Remittance File (RA File). This will be sent out during the first week of the following month. For example:
Claims created: June 20th - July 20th
Remittance file sent: First week of August
Payment: August 15th.
Once the RA file is downloaded from the MOH server and into CabMD, CabMD will move the associated claims into your Paid section. You can then go in and check the claim to see what has been paid by the MOH.
Step 4: Around the 15th of the month, the MOH will send out the checks based on the RA file. When you sign up for a billing number with the MOH, you set up your billing information with them. For most users, payment is made through direct deposit. If you wanted to set this up, there is a .PDF form online for you to fill out and send into the Ministry. The form can be found here.
The payment date is shown on the remittance report found in CabMD. This is the icon in your File Centre > EDT Files that looks like a magnifying glass over a piece of paper.
The payment amount will be the same amount as shown on the remittance file.
Step 5: If you want to check the Paid Reports (detailed) against the RA file, you have to keep Adjustments in mind. An Adjustment is a change in the payment from the MOH, whether its a service code that has already been claimed or a % change. They show up in two ways:
On your RA report there is a section under the payment amount that shows the adjustments. If the number has ( ) around it, it's a reduction. If it does not, it's an addition.
On the Paid Report, the lines in red show that an adjustment has been made on the claim. The lines in black are claims that have been paid in full. If there is an adjustment, there will be the code "ADJ" next to the claim. There will also be an explanatory code (Exp. code) next to the claim. On the last page of the paid report there will be a legend explaining what these codes mean. If the adjustment includes changing a service code for another, the service code will be in red and the new code will be next to it.