Submitting Claims

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Overview

The Claims tab is your primary tool for creating and submitting claims on mobile. The streamlined interface is optimized for quick entry.

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Accessing the Claims Form

Tap the Claims tab (first icon) in the bottom navigation.

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Creating a Claim

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Step 1: Patient Information

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Step 2: Service Details

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Step 3: Billing Information

1. Billing Code - Search or select from recent codes
2. Quantity - Adjust if more than one unit
3. Fee - Auto-calculated based on OHIP schedule

Tap Add Code to include additional billing codes.

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Step 4: Diagnostic Code

Select the appropriate diagnostic (ICD) code that justifies the billed services.

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Step 5: Comments (Optional)

Add notes or tags for your reference. These don’t appear on the submitted claim.

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Health Card Validation (HCV)

The app validates health cards against OHIP’s HCV service:

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Fee Calculation

Fees are calculated automatically:

• Base fee from current OHIP schedule
• Quantity multipliers
• Complex code calculations (percentages, premiums)

The total appears at the bottom of the form.

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Submitting the Claim

1. Review all information
2. Tap Submit
3. Confirm the submission
4. View success screen with claim details

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Saving as Draft

Not ready to submit?

• Tap Save Draft
• Access later from Records tab
• Filter by “Draft” status

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Favourite Sections & Combos

Organize your most-used billing codes into sections for faster claim entry on mobile.

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Setting Up Favourite Sections

1. On the Claims screen, tap + Add Favourite next to Billing Codes
2. Create sections (e.g. “Office Visits”, “Consults”) to group related codes
3. Long-press and drag codes to reorder them within a section
4. Tap a code pill to move it between sections or remove it
5. Swipe left and right to navigate between sections

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Creating Combo Favourites

Combos let you add multiple billing codes with a single tap — useful for services you always bill together.

1. In the Favourite Sections editor, tap the Combo button in a section
2. Tap “Tap to select codes…” and choose two or more billing codes
3. Optionally enter a custom label (e.g. “Office Visit + ECG”)
4. Tap Save Combo

Combo favourites appear as blue pills in the favourites carousel. Tapping a combo adds all its codes to the claim at once.

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Duplicating Claims

For similar services:

1. Tap the copy icon in the header
2. Previous claim details are copied
3. Modify as needed (patient, date, etc.)
4. Submit the new claim

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Common Issues

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”Invalid billing code”

• Verify the code exists in current OHIP schedule
• Check for typos
• Some codes require specific conditions

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”Patient not eligible”

• Verify health card number and version code
• Check service date eligibility
• Patient may need to update their card