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Overview

The New Claim form guides you through creating and submitting claims with built-in validation and automatic fee calculation.

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Accessing the New Claim Form

  1. Click New Claim in the sidebar navigation
  2. Or click the + button from the Claims page

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Required Information

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Patient Information

1

Health Card Number

Enter the patient’s 10-digit OHIP health card number. The system validates the card format automatically.
2

Version Code

Enter the 2-character version code from the health card.
3

Patient Details

The system auto-fills patient name and date of birth if the patient exists in your records. Otherwise, enter:
  • First name
  • Last name
  • Date of birth
  • Sex

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Service Information

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Billing Codes

Add one or more billing codes for the services provided:
  1. Search for the billing code or select from your frequently used codes
  2. Enter the quantity (number of units)
  3. The fee calculates automatically based on the OHIP schedule
  4. Add additional codes as needed

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Diagnostic Codes

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

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Fee Calculation

The system automatically calculates:
  • Individual service fees based on billing codes
  • Quantity multipliers
  • Total claim amount
Fees are based on the current OHIP Schedule of Benefits. Complex billing scenarios (percentage-based codes, premium codes) are calculated automatically.

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Validation

Before submission, the system validates:
  • Health card number format
  • Required fields are complete
  • Billing code compatibility
  • Diagnostic code requirements

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Submitting the Claim

  1. Review all entered information
  2. Click Submit
  3. Confirm the submission
  4. View the success confirmation with claim details

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Saving as Draft

Not ready to submit? Click Save as Draft to save your progress. Access drafts from the Claims page with the “Draft” filter.

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Favourite Sections & Combos

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

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Setting Up Favourite Sections

  1. On the New Claim screen, click + Add Favourite next to Billing Codes
  2. Create sections (e.g. “Office Visits”, “Consults”, “Procedures”) to group related codes
  3. Drag and drop codes to reorder them within a section
  4. Click a code pill to move it between sections or remove it

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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, click the Combo button in a section
  2. Select two or more billing codes for the combo
  3. Optionally enter a custom label (e.g. “Office Visit + ECG”)
  4. Click Save Combo
Combo favourites appear as blue pills in your favourites bar. Tapping a combo adds all its codes to the claim at once.
Combos are especially helpful for common service bundles you bill repeatedly, like a consultation with associated procedures.

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Tips for Efficient Billing

  • Use the Duplicate feature to copy a previous claim for similar services
  • Set up frequently used billing codes in your profile
  • Use the Calendar view for bulk entry of recurring appointments