If you feel that your claims were underpaid or overpaid, you can create a Remittance Advice Inquiry (RAI) entry that will allow you to draw the attention of the MOHLTC to the matter. To do this is quite simple, and the following tutorial will help you create that RA Inquiry.
Step 1: When you navigate to your paid claims in your CabMD account, you may notice a red money ($) icon. This icon will appear whenever there is an adjustment from the MOH on your claims. On the list of paid claims, you can hover your mouse and over the red icon to see the historical information of how the claim was paid. This will make a small message appear that will break down the service codes by explanatory code and what the code was paid.
Step 2: To create the RAI entry, simply click on the circle with the question mark on the far left of the claim.
When you click this icon, a new window will open with the necessary form fields to allow you to create the RAI form automatically.
Step 3: First, select the service code you wish to refer to (you must select one and only one). Select whether you were underpaid or overpaid for this service code. In the remarks section, write a brief comment as to why you thought this needed to be adjusted. If there are multiple service codes you wish to report, write the other service codes with a description in the remarks section. This will all be added to the same RA Inquiry report.
When you finished, click the "Generate" icon at the bottom.
Step 4: Once the inquiry entry has been created, you have to then print and mail (or fax) the inquiry to the local MOHLTC office you have setup in your care provider settings. To do this, click on File Centre > RA Inquiry Files on the CabMD menu.
To open the RA Inquiry in it's form, click on the green trillium. This will open a new window that will contain the completed form. You can then print this form using the print icon at the bottom of the window, or right-click and print. Once it is printed, the form must be sent to the MOHLTC office for review. You can send by mail/fax or the new eSubmit system.
As per OHIP bulletin 17-002 - starting February 1, 2017, the first phase of eSubmit will allow health care providers to electronically submit a remittance advice inquiry or supporting documentation, such as operative reports, consult report/notes, etc.required to adjudicate complex claims.
To submit documentation through eSubmit:
Login to GoSecure
Navigate to eSubmit
Select "Remittance Advice Inquiry" from the eSubmit English Forms
Select "Ontario Health Service Provider/Designate" and complete the required fields using the information from the form generated by CabMD.
Attach the generated RAI form under "Attachments/Remarks"