Your First Claim

This guide walks you through creating and submitting your first OHIP claim.

Prerequisites

Before you begin, make sure you have:

Connected your OPS BPS account
Added at least one patient to your directory

Step 1: Start a New Claim

From the Claims page, click New Claim in the top-right corner. This opens the claim creation form.

Step 2: Select a Patient

Start typing the patient’s name or health card number. SnapBill will search your patient directory and show matching results. Select the correct patient.

If the patient doesn’t exist yet, you can create them inline without leaving the claim form.

Step 3: Add Billing Items

Each claim can contain one or more billing items. For each item, enter:

Service code — the OHIP billing code (e.g., A007 for a general consultation). You can search by code or description.
Service date — the date the service was provided
Diagnostic code — the OHIP diagnostic code for the visit (e.g., 000 for general assessment)
Number of services — defaults to 1

The fee is automatically looked up from the Schedule of Benefits.

Optional Fields

Depending on the service, you may also need to provide:

Facility — the hospital or clinic master number
Service location — where the service was performed (e.g., office, hospital, home visit)
Referring physician — the OHIP number of the referring doctor
Admission date — for in-patient services
Payment program — defaults to HCP (Health Care Plan), but can be set to WCB or RMB

Step 4: Review and Save

Review the claim details. SnapBill performs real-time validation and will flag any issues:

Invalid or expired health card
Missing required fields (e.g., diagnostic code, facility for hospital services)
Billing code restrictions (e.g., age limits, specialty requirements)
Duplicate claims for the same patient and date

Fix any flagged issues, then click Save. The claim is saved with a status of Pending Submission.

Step 5: Submit to OHIP

You can submit claims individually or in batches. See Submitting to OHIP for the full process.

From the Claims page:

Select the claims you want to submit (or use Select All)
Click Submit to OHIP
Review the submission summary
Confirm to generate the claim file and upload it to MCEDT

What Happens Next

After submission:

Claims move to Submitted status
OHIP processes them within 2-3 weeks
Remittance advice appears in your Submissions page
Payment status updates automatically via reconciliation

Tips

Submit claims regularly (weekly or bi-weekly) rather than waiting until the deadline
Use the Schedule of Benefits to look up codes and fees
Set patient defaults (diagnostic code, facility, referring physician) to speed up future claims
The AI Chatbot can answer questions about billing codes and rules