Create Ontario Electronic Billing Files

Admin Corner with Electronic Bill Files Popup shown

2. On the first page of the Administrators Corner in the third column, fourth button down is the Electronic Bill Files Popup. Click on the Popup and select E-Bill File.

3. After selecting the E-Bill File an alert box will come up that will ask if you would like to Check All Billings 1st. If you choose to do this, MediFile will go through all the billings that are flagged to be sent to OHIP. It will check each of these billings against the rules as contained in the fee Code, price modifier files. Once it finishes the check MediFile will report back to you what

Generate E-Billing File alert box.

MediFile checking the Billing Records to be sent

The figure above shows MediFile checking the billings. In this case it has checked 158 of the 421 claims marked to be sent. MediFile tries to send all billings that are marked with the status of created.

Reported problems with Billing flagged to be sent

This dialog will be displayed after the checking of all billings flagged to be sent are checked. This report gives you a good idea as to the number of problem billings, and the reason for the problem. In the checking process the billings with a problem will be flagged with a `Hold'for their status, and will have the reason for the hold entered into the Code Out field of each billing record.

To fix the problem billings you can find them by searching for all the billings with a status of HOLD. You can choose to do this another time, or right away before you generate the E-Bill File. You will be given this opportunity after you click on the DONE button in the Check Billing Dialog.

Create the E-Bill File after checking the file

To fix the claims, click on the Cancel button in the Press OK to Create E-Bill File dialog. If you want to generate the billings right then, and fix the other claims later, click on the OK button.

Selecting Month to Generate File For

Before generating the electronic billing file, MediFile asks you for the month and year of the file you want to generate. MediFile does this as the file name must be named in a specific manner depending on month and year that the file is generated for.

Clicking on the OK button at this dialog will start the process of creating the electronic billing file.

MediFile showing the status of the File Generation - account JM, on billing 5 of 5

MediFile generates the billing in the following manner.

• MediFile gets the OHIP submit code from the admin preference record.

• MediFile searches in the billing file for all records that have a status of `Created' and have a date seen less than the 1st day of the month selected in the Select Month dialog. Within the selection of records found it looks for all the billings with the clinic submit code for OHIP contained in the Functional Center field, or where WCB field is marked.

• If there are billing records to be sent in, MediFile creates a file on your local hard drive with a name as per dictated by OHIP. The file will be created in the ToSend folder.

• Searches for all area accounts that have a PN number in the Area Account file. If an account does not have an PN number then that account will not have any electronic billing records created for it.

• MediFile then searches for the billing records as indicated in the previous step, but only for a specific area account. This has the result of placing all the billings for one area account together.

• MediFile needs to assign an accounting number to each billing record if it doesn't already have one. At this point MediFile goes to the BillingCounter file and gets the next batch number and the next accounting number.

• As per OHIP requirements, MediFile now sorts all the billings to place all the billings in order of Patient, Date Seen, and time. This will have the effect of having all billings for the same encounter be together. If they are not together, OHIP will not process the claim properly.

• MediFile now creates a record for your tracking information into the BillBatch file. The record is created with the batch number, current date, area account, and the first claim number. This way you can track what billing records have been sent in for each area account.

• For each billing record MediFile checks the billings again. If it finds any problems it will not send the billing. For problem records MediFile will give the billing a status of HOLD, and in the Code Out field indicate with words the reason for placing the billing on hold.

• If the billing passes the check, then an accounting number is assigned to the billing record if it doesn't already have one. If the 1stSent field is blank, then the current date is placed in the field. The LastSent date field gets the current date. The NumTimesSent field gets incriminated by one.

• The reconcile_Comme field get the sending information added to it. This fields stores all the sending and reconcile information stored in it.

• The status of the billing is changed to `Sent'.

• The information required by OHIP is now added to the electronic billing file on disk.

• Once all the area accounts' billings have been processed the electronic billing file on disk will be closed and a dialog showing you the results of the creating of the electronic billing file. An example is shown here.

Results of Billing File Creating

In the dialog showing the results of the file generation you will see the following information.

• Total number of claims sent in

• Total number of records created

• Total dollar value billed

• For each account the dollar amount billed, and the number of transactions for each area account.

• When you close this dialog MediFile will automatically save this report in the Alert file. It will be saved in the Alert file with a task name of `ON_GenEBillTxt'. It will be saved with the current date, time, and the user's name.

Clicking on the Print Summary button will print the report shown on screen to be printed on paper.

Clicking on the Print Detail button will print out a detailed listing of all the billings that were sent in the file that was created in this session. This report will print out the claims by Area Account. It will show the patient's name, MediFile #, Claim number if there is one, ICD codes, HSCode, and amount of billing.

User Tip : You can view the actual E-Billing document through the MediFile© Word Processor. Unless you are very sure of what you are doing, you should not do this as it is very easy to disturb the very specific format of the file. Of course you could make a copy of the file and then view the copy.

HSO Preference Settings

These preferences are found in the Admin corner page 3 - Preferences. They are on the Prov Specific Page of the preferences.

Steps to Generate HSO - Encounter File

• From the Electronic Bill Files popup select HSO-Encounters

Selecting HSO-Encounters

• In the Select File Date Dialog select the month and year that the file is to be generated for. Use the popup for the month, and enter the year by typing. MediFile will default to the current month, and the current year.

Select Month to Generate Dialog

• Once you click on the OK button MediFile searches for encounter billing records to send in. It searches for all billing records that have a status of `Created', the date of service (date seen) is less than the 1st day of the month you selected in the Select Month to Generate Dialog. It also looks for all billings that have a functional center that is equal to the HSO number in the Admin Preferences.

Creating of HSO Encounter File Progress Dialog

• As MediFile generates the file you will be kept informed of the progress. From this you can have an idea from past experience as to how long it is likely to take. In the figure shown there are 127 records to place in the file, and MediFile is on the 27th record.

The file that MediFile creates will be saved in the ToSend folder. The HSO program dictates what the file name needs to be. The first file name will always start with an `E'. If more than one file is create each subsequent file will get a number plus a dash before the E in the file name.

• MediFile will create a record in the BillBatch file. This is to provide you with a record of the file being created. It will create a record with a BatchType of `HSOEncounter', and an Account of `All'.

• For each billing record that MediFile attempts to add to the HSO Encounter file, MediFile checks the record first to ensure all the required information is contained in the file. If there are problems with the record MediFile will report these at the end of the process. It will also record these in the billing record.

• If the file passes the MediFile check, then information will be added to the billing record. The datelast send will be updated. The number of times sent will be incriminated by one, and the date first sent will be filled with the current date if this is the first time that the record has been sent in, and finally the sending information is added to the Reconcile_Comme field of the billing record.

• As each billing record is added to the disk file, the billing record is assigned an accounting number. The accounting number is obtained from the [BillingCounter] file.

HSO Encounter File Generation Results

This dialog will be shown at the end of creating the file. It tells you the number of records sent, the name of the file, and the problems. If more than one file was created, each file name will be displayed with the number of lines in each file.

Selecting HSO - Roster from Electronic Bill Files Popup

• MediFile will then confirm that you really want to do this. It does this through a confirmation dialog as shown here. Click on the OK button to generate the file.

As with the HSO - Encounters file generation, MediFile gets the HSO number from the preference record. Therefore this information must be filled in.

Confirmation dialog for Roster File creation

• As MediFile generates the file you will be shown the progress of the file generation in a window.

File generation progress window

In the dialog above you are shown that there are 204 patient records to be added to the roster file. MediFile is currently adding the 14th record.

To determine which patients, and what patient information needs to be added to the HSO Roster file MediFile searches in the Patient file for all patient records where the HSOUpdate field is not blank.

• When the file is finished being generated a dialog showing what was done, and any problems MediFile encountered will be shown.

HSO Roster Problem List

The dialog shows the number of records sent, each problem record. With each problem record there is the Patient's MediFile number shown with the problem indicated beside it. You can fix these so that they will be included in the next file you send in.

• When you click on the Exit button of this dialog MediFile will write this report to the Alert file.

• MediFile will then ask you if you want to blank out all changes to the patient records that were included in the HSO Roster file. Those patient records that had a problem will not be cleared. As the alert warns this is not reversible. Of course if you do not do this now, these changes to the patient's records will still be in the system. Next time you send in the HSO - Roster file they will be included again.

Clear HSO update Field Confirmation Dialog