When editing a claim, at the bottom of the screen there is a section titled "Payment Details". Clicking on that section opens up the payment options for the claim, including "Billing Method" (ie. which group should this claim be paid under), Payment Program (almost always HCP unless the claim is for a non-Ontario patient for an OHIP service provided in Ontario) and Manual Review.
Click the manual review checkbox and save the claim. When you submit the claim, it will be marked as "manual review" for the MOHLTC.
If you are required to send the manual review form, you should now see the claim under File Centre → Manual Review Forms. Click the Trillium icon to generate the pre-filled form, allowing you to print or you can also download and submit through eSubmit
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 "Supporting Documents" 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 Manual Review form and other documents under "Attachments/Remarks"