Submitting Remittance Advice Inquiry

Transcription

1 Ministry of Health and Long-Term Care esubmission of Medical Claims Supporting Documentation Step-By-Step Guide To: Submitting Remittance Advice Inquiry Claims Services Branch Direct Services Division Ministry of Health and Long-Term Care (MOHLTC) Version 1.0 August 8, 2017

2 Submitting Remittance Advice Inquiry Accessing esubmit esubmission of Medical Claims Supporting Documentation 1. Go to the Government of Ontario GO Secure Login screen at: 2. Log into GO Secure by entering your GO Secure ID ( address) and Password and select Sign In. NOTE: Your GO Secure session will time-out if there is no activity after fortyfive (45) minutes. 3. Select Services on the Health Care Provider s Administration and MOHLTC Service Menu. SUBMITTING REMITTANCE ADVICE INQUIRY Page 2

3 4. Select using down arrow to see services: 5. Select esubmit 6. Select Access Service the esubmit Main page appears. SUBMITTING REMITTANCE ADVICE INQUIRY Page 3

4 7. The esubmit Main page will open. NOTE: If a health care provider is a designee for another health care provider, the Working on Behalf of field will be available. Working on Behalf of list will default to Myself, any health care provider that you are a designee of could also be selected. All Designees will have the Working on Behalf of field on their Administration and MOHLTC Services. 8. Using the down arrow for the Working on Behalf of field, view the list of names of Providers. If the Provider for which you have permissions granted is not listed, use the Search option and enter the Billing number or provider name in the Search field. SUBMITTING REMITTANCE ADVICE INQUIRY Page 4

5 NOTE: If you are a Designee, the Administration and MOHLTC Service page will display a Working on Behalf of field to allow you to select a provider. The default for this field is Myself but this field can be changed by using the down arrow or Search field to locate a list of provider(s) for which you have been granted permissions to download files for. To do a search, enter either the Billing number or Name of the provider. 9. Once found, select the Provider. 10. Using the drop down for the Services field, two options are available: esubmit or MC EDT (Upload/Download). Select esubmit. SUBMITTING REMITTANCE ADVICE INQUIRY Page 5

6 11. Select the Access Service button. The esubmit Main page will open. 12. To open and close a menu of the types of electronic submission available select the arrow to the left of esubmit English Forms. SUBMITTING REMITTANCE ADVICE INQUIRY Page 6

7 13. Select the type of electronic submission you want to send to the ministry: Supporting Documentation Remittance Advice Inquiry (RAI) Additional Information Requests Remittance Advice Inquiry Select Remittance Advice Inquiry from the esubmit MAIN page. SUBMITTING REMITTANCE ADVICE INQUIRY Page 7

8 The Remittance Advice Inquiry form (see below) has three main sections that need to be filled out: Contact Information Remittance Advice Inquiry Details Attachments/Remarks Note: The fields with one asterisk are * Mandatory and the fields with two asterisks ** are Conditional (one or the other must be present). Mandatory fields may change depending on selections. SUBMITTING REMITTANCE ADVICE INQUIRY Page 8

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10 Near the bottom of the screen there are three buttons: Cancel (returns you to the previous screen) Clear Fields (removes any information that has been entered, the form template remains on the screen). Submit (will submit the completed form; if the form is not completed or completed incorrectly an error message will appear). Contact Information Section In the Contact Information section the first field I am a *, is a mandatory field with two choices: 1. Ontario Health Service Provider/Designate 2. Out of Country Registered Third Party Billing Agent The choice made here affects what fields in the rest of the Remittance Advice Inquiry form will be mandatory or auto populated. Selecting the Ontario Health Service Provider/Designate radio button makes the Group # (four alpha numeric); Solo # (six numeric), Speciality # (two numeric) fields mandatory. The Address field is always mandatory (ensure correct formatting is used). If you are submitting an RAI as a Solo provider, you need to enter 0000 in the Group # field. Selecting the Out of Country Registered Third Party Billing Agent radio button makes all fields mandatory, including the Account Number (up to eight alpha numeric). SUBMITTING REMITTANCE ADVICE INQUIRY Page 10

11 Remittance Advice Inquiry Section esubmission of Medical Claims Supporting Documentation When the Ontario Health Service Provider/Designate radio button is selected (in the Contact Information section) the My submission is for an * field is a mandatory field with two choices: 1. Ontario HN 2. Out of Province HN When the Ontario HN radio button is selected, the Health Number field becomes mandatory. Enter the Ontario Health Number (10 numeric). When the Out of Province HN radio button is selected the Out of Province HN field becomes mandatory. Enter the Out of Province Health Number (up to 12 alpha numeric). When the Out of Country Registered Third Party Billing Agent radio button is selected from the My submission is for an field, in the Contact Information section, the Ontario HN radio button is automatically selected and the Ontario Health Number field is mandatory. In the Remittance Advice Inquiry Details section, the Claim Number (one alpha and ten numerics) and Date of RA fields are always mandatory. It is important that the correct format is used when filling in these fields. SUBMITTING REMITTANCE ADVICE INQUIRY Page 11

12 The correct format for the Date of RA is yyyy-mm-dd. The date may be keyed in the Date of RA field or selected from the calendar. If keying the date, enter 01 as the day. If using the calendar feature select the first day of the month. Using the calendar feature is recommended to ensure the date format is correct. To use the calendar feature select the calendar icon to the right of the Date of RA field. In the calendar pop up, select the correct date and select OK. In the Remittance Advice Inquiry Details section (under the Claim Number and Date of RA fields ) there is an area to list the details of the claim in question. There is capacity to add up to ten rows here, but at least one row is mandatory. The first blank row is already entered. To populate the row, insert the cursor under Fee Code. Enter the Fee Code (one alpha, three numerics, one alpha). Use the tab key to move to the # of Services field and enter the number of services (0-99). Tab to the Fee Billed field and enter the Fee Billed ( ). Tab to the Service Date field and enter the Service Date using the proper format (yyyymm-dd). All fields are mandatory. To populate the Inquiry Type field, select the drop down arrow on the far right side of the row. A menu of three options opens: Correction, Overpayment, and Underpayment. Select the option that applies. This field is mandatory. SUBMITTING REMITTANCE ADVICE INQUIRY Page 12

13 To add or delete rows, use the Add Row and Delete Row buttons. One row is mandatory and a maximum of ten rows are available. Note: Any blank rows must be deleted before submitting. Attachments/Remarks Section It may be necessary to scroll down to the Attachments/Remarks section of the Remittance Advice Inquiry form. It is below the Claim Details section. The Attachments/Remarks section consists of two main parts. The Attachment List field and the Provider/Group Remarks field are conditional, one or the other must be populated. SUBMITTING REMITTANCE ADVICE INQUIRY Page 13

14 Attachments esubmission of Medical Claims Supporting Documentation To include an attachment, select the Add button and the Add Attachment window opens. Note: Up to ten attachments can be included per submission. The file size for each attachment, cannot exceed 5MB. Select Browse to add individual attachments. The Choose File to Upload window will open. Find and select the file to be attached. Select Open. SUBMITTING REMITTANCE ADVICE INQUIRY Page 14

15 When all files have been attached, select OK. esubmission of Medical Claims Supporting Documentation The files are now attached to the Remittance Advice Inquiry form. Check the file name to ensure that the correct file(s) were attached and that each file does not exceed 5MB in size. In the Provider/Group Remarks field, enter remarks or comments regarding the Remittance Advice Inquiry, if applicable. Once the Remittance Advice Inquiry form is completed correctly, select the Submit button to send the completed form and attachments or remarks to the MOHLTC. SUBMITTING REMITTANCE ADVICE INQUIRY Page 15

16 Once the Submit button has been selected, a Confirmation window opens, asking: Have you completed all the fields on the form and attached all relevant documents? Select Yes to finalize If the Remittance Advice Inquiry form is incomplete or a field is not formatted correctly, a warning will appear at the top of your screen indicating the error. Select No to return to the form. SUBMITTING REMITTANCE ADVICE INQUIRY Page 16

17 Note: Once the Remittance Advice Inquiry form has been successfully submitted, an response from the MOHLTC will be sent confirming receipt of your submission. The will quote a Ticket Number. Retain your Ticket Number. Inquiries regarding your submission will require this number. The response to the RAI will be sent to your MC EDT account, no notification will be sent. For more information: 1. Who do I contact if I have esubmit questions? Contact Service Support Contact Centre (SSCC) at: The desk is staffed from 8:00 a.m. to 5:00 p.m., Monday to Friday. After business hours an answering service is available and your call will be returned the following business day. 2. Who do I contact if I have technical questions or issues? Contact your software vendor for any technical questions or issues. 3. Where are the OHIP Processing offices located? Select the following link for a list of OHIP Processing offices. SUBMITTING REMITTANCE ADVICE INQUIRY Page 17