Ontario E-Billing File Input Field Relationship
Date of Tech Note: 19 Jun 1999
Enhancement:
Bug Fix: N/A
Description
The generation of the E-Bill file is certainly one of the most crucial elements of a Medical Office system. Therefore the need to understand this is absolutely important.
Detail
This document describes the field relationships between the fields in MediFile and the data required by OHIP. This document describes the place where the data is obtained at the time of generation of the E-Bill file. With this knowledge you will be able to understand how a problem was created, and how to fix it.
Refer to the OHIP Technical Specifications Interface to Health Systems from the Ministry of Health of Ontario. In that manual, specifically examine the Batch Header Record chapter.
Batch Header
Input Information MediFile Data Field
Transaction Identifier Hard coded ‘HE’
Record Identification Hard coded ‘B’
Tech. Spec. Release ID Hard Coded ‘V03’
MOH Office Code Admin Preferences - Prov Specific Page
×aAdminPrefs{26}
Batch Identification Calculated at time of file generation
Operator Number Not required for disk of Modem submission
Group #, IHF for groups this entered by user when asked which file
to generate for. For individual submissions this is hard
coded to be ‘0000’
Health Care Provider # [Accounts]ULI
Specialty [Accounts]SkillCode1
Claim Header-1
Input Information MediFile Data Field
Transaction Identifier Hard coded ‘HE’
Record Identification Hard coded ‘H’
Health Number [Patients]HC_Num
Version Code [Patients]VersionCode
Patient’s Birthday [Patients]Birthday
Accounting Number [Billing]AccountingNo
This field may have been filled at the time of generation. It
is a sequental number obtained
from [BillingCounter]ClaimSequence
Payment Program If [Billing]WCB is true ‘WCB’
If [Billing]Agency = ON --> ‘HCP’
If [Billing]Agency # ON --> ‘RMB’
Payee [Billing]PayTo
Ref Doc’s Provider # [Doctors]ULI - This will only be filled if one is required.
otherwise the spot will be filled with 6 spaces
Facility Number [Billing]FacilityNumber - This is only to be sent if at a
hospital, or other facility with a facility assigned by OHIP.
In - Patient Admission Date [Billing]HospAdminDate
Referring Lab Licence Number Always send in 4 blank spaces (Not supported at this time)
Only meant if sending in as a Lab.
Manual Review Indicator [Billing]Intercept
Location Code [Billing]Location
Claim Header-2
Only for non Ontario claims (reciprocal billings - RMB)
Transaction Identifier Hard Coded to ‘HE’
Record Identification Hard Coded to ‘R’
Registration Number [Patients]HC_Num
Patient’s Last Name [Patients]Surname (Only the 1st 9 valid characters)
Patient’s First Name [Patients]Given (Only the 1st 5 valid characters)
Patient’s Sex [Patients]Sex (‘1’ for Male, ‘2’ for Female)
Province Code [Billing]Agency
Item Record
Transaction Identifier Hard Coded to ‘HE’
Record Identificationh Hard Coded to ‘T’
Service Code [Billing]FeeCode
Fee Submitted [Billing]Amount (with the decimal removed)
Number of services [Billing]Calls
Service Date [Billing]DateSeen
Diagnostic Code [Billing]DiagCode
Second Item
This is only filled if we have a modifier
Service Code [Billing]Modifier1
Fee Submitted [Billing]Amount - [Price_Modifier]Amount OR
[Billing]Amount / [Price_Modifier]Amount
Number of services [Billing]Calls
Service Date [Billing]DateSeen
Diagnostic Code [Billing]DiagCode
Batch Rrailer Record
Transaction Identifier Hard Coded in ‘HE’
Record Identification Hard Coded in ‘E’
H Count count the total # of Claim Header 1 records
R Count count the total # of Claim Header 2 records
T Count count the total # of Claim Item records
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