Ministry of Health and Long-Term Care

eSubmission of Medical Claims Supporting Documentation

Submitting Supporting Documentation

Claims Services Branch Direct Services Division Ministry of Health and Long-Term Care (MOHLTC)

Version 1.0 August 2, 2017

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eSubmission of Medical Claims Supporting Documentation

Accessing eSubmit 1. Go to the Government of Ontario (GO) Secure Login screen at:

https://www.edt.health.gov.on.ca

2. Log into “GO Secure” by entering your GO Secure ID (email address) andPassword and select “Sign In”.Password and select “Sign In”.

NOTE: Your GO Secure session will time-out if there is no activity after forty-five (45) minutes.

3. Select “Services” on the Health Care Provider’s Administration and MOHLTCService Menu.

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4. Select using down arrow to see services:

5. Select “eSubmit”

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6. Select the “Access Service” button.

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 ofnames of Providers. If the Provider for which you have permissions granted isnot listed, use the Search option and enter the Billing number or provider namein the “Search” field.

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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: eSubmitor MC EDT (Upload/Download). Select ‘eSubmit’.

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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 availableselect the arrow to the left of eSubmit English Forms.

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13. Select the type of electronic submission you want to send to the ministry:

• Supporting Documentation• Remittance Advice Inquiry (RAI)• Additional Information Requests

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Supporting Documentation Submission

Select “Supporting Documentation” from the eSubmit Main page.

The Supporting Documentation Submission form (see adjacent) has three main sections that need to be filled out:

• Contact Information Section• Claim 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.

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).

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Contact Information Section

In the Contact Information section 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 Supporting Documentation Submission 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 Email Address field is always mandatory (please ensure proper formatting is used). If you are submitting supporting documentation 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).

Claim Details Section

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

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When the “Ontario HN” radio button is selected the “Health Number” field becomes mandatory, enter the “Health Number” (10 numeric).

When the “Out of Province HN” radio button is selected the “OOP HN” field becomes mandatory, enter the “OOP HN” (up to 12 alpha/numeric).

It is important that the correct format is used when filling in the “Service Date”.

The correct format for the Service Date is (yyyy-mm-dd). The Service Date may be keyed in the Service Date field or selected from the calendar. Using the calendar feature is recommended to ensure the Service Date format is correct. To use the calendar feature select the calendar icon to the right of the Service Date field.

In the calendar pop up, select the correct date and select OK.

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Attachments/Remarks Section

It may be necessary to scroll down to the Attachments/Remarks section of the Supporting Documentation Submission form. It is below the Claim Details section.

The Attachments/Remarks section consists of two main parts. The Attachment List field is mandatory and must have at least one attachment. “The Provider/Group Remarks” field is optional.

Attachments To include an attachment, select the “Add” button and the Add Attachment window opens.

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NOTE: Up to 10 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.

When all files have been attached, select OK.

The files are now attached to the Supporting Documentation Submission form. Check the file name to ensure that the correct file(s) were attached and that each file does not exceed 5MB in size.

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In the “Provider/Group Remarks” field, enter remarks or comments regarding the Supporting Documentation Submission, if applicable.

Once the Supporting Documentation Submission form is completed correctly, select the “Submit” button to send the completed form, attachments and remarks to the Ministry of Health and Long-Term Care (MOHLTC).

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 your submission or “No” to return to the form.

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If the Supporting Documentation Submission form is incomplete or a field is not formatted properly, a warning will appear at the top of your screen indicating the error. Select “No” to return to the form.

NOTE: Once the Supporting Documentation Submission form has been successfully submitted an email response from the MOHLTC will be sent confirming receipt of your submission. The email will quote a Ticket Number. Retain your Ticket Number. Inquiries regarding your submission will require this number.

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For more information:

1. Who do I contact if I have eSubmit questions?

Contact Service Support Contact Centre (SSCC) at: 1-800-262-6524. The deskis staffed from 8:00 a.m. to 5:00 p.m., Monday to Friday. After business hours ananswering service is available and your call will be returned the followingbusiness day.

2. Who do I contact if I have technical questions of 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.

http://www.health.gov.on.ca/en/pro/programs/ohip/claimsoffice/default.aspx