Welcome to ClinicAid
Thanks for signing up for ClinicAid! We hope our web-based medical billing software will enable you to bill the Ontario Ministry of Health and Long-Term Care (MOHLTC) quickly and easily!
Now that you’ve signed up, you should have already received your login details via email to access your account. You can start the process of getting set up for billing by logging into your ClinicAid account.
Go to the Clinicaid.ca homepage and click on the Login button. Enter your login credentials to access your account. We recommend using Mozilla Firefox or Google Chrome for any of your ClinicAid activities as these are the browsers that will work best with ClinicAid. We don’t advise using Safari or Internet Explorer for your ClinicAid billing purposes.
Once you’ve logged in with your email address and password, you will reach your Dashboard which should show 0 Unsubmitted Invoices and 0 Invoices Requiring Action when you first start out. You’ll need to set up your account in order to begin creating and submitting your bills properly through Ontario’s Medical Claims Electronic Data Transfer (MC EDT) system. This is a step-by-step guide to how to do just that!
Setting up your provider record:
The first thing you’ll need to do in order to complete your account setup is to create a provider record for each of the physicians that the billing will be done for in ClinicAid. If you’ve already been in touch with one of our support reps, this step may already be partially or fully completed for you.
In case you haven’t had your provider records set up yet, here is what you’ll need to do: Provider Record step-by-step instructions.
Below is some information about what each section means when adding your provider record:
Claims Office: Submitted claims will be sent to one of the specifically designated claims offices in Ontario. These offices were previously based on geographical location, but recent changes to assignment procedures may have affected your claims office location.
If you’re unsure which claims office you belong to, the best way to confirm is to give the OHIP Service Support Centre a call at 800-262-6524 or to email them at SSContactCentre.MOH@ontario.ca.
Visit Location: The Visit Location, also known as “Master Number”, is generally required for services provided in larger health facilities such as hospitals and extended care centres. This is a 4 digit code that identifies the specific facility. In ClinicAid, Visit Location is a lookup field that can be typed into to search for the correct code. Simply type in the name of the hospital and select the correct facility from the search results that appear in the list. (If you are not providing services at a hospital, you can enter the code 0000 - No Location. If you leave this field blank, your claims will have this location (0000) set by default.)
Group Number: To be completed only if you are using a group billing number for your claim submission payments. This is generally applicable to practitioners who work at clinics with multiple practitioners on staff where the clinic is receiving payment from the Ministry and is then responsible for paying out each physician. This can also be the group number assigned to the hospital or PHU that coordinated the vaccine service delivery.
Specialty: A two-digit code that identifies your specialty (e.g. 00 - Family Practice and practice in General, 19 - Psychiatry, etc.). This field is also searchable and can be typed into if you’re unsure of your specialty’s code.
Service Location Indicator (SLI): A 3 letter code that specifies where in a hospital or care centre (Visit Location) the service was performed. There are currently 8 options to choose from, as well as the default option, 3821 - Not Applicable. If you leave this field blank, your claims will autocomplete with the 3821 SLI code.
Shadow Billing: This is done by physicians who do not work in a fee-for-service model (e.g., practitioners who work in Family Health Teams (FHTs)). Shadow billing involves submitting information about the services that have been provided but not for the purpose of reimbursement. Shadow billings are claims submitted by physicians and nurse practitioners who are paid a salary or who work under a contract.
Override MUID (Override GoSecure Credentials For This Provider checkbox): This is a special setting used to set up the connection between ClinicAid and OHIP’s Medical Claims Electronic Data Transfer system. Checking this box when setting up or editing a provider’s record allows the user to override the global GO Secure details that are set in the Admin section for the entire account. GO Secure credentials are required in order to connect the ClinicAid account directly to OHIP’s MC EDT submission system. This indicator should be used in situations where there are multiple physicians using one ClinicAid account, but some or all have their own individual GOSecure credentials that they are using for their particular claims.
Once you’ve completed all of the fields and saved the record, you should see a new provider displayed in the account which, if viewed by clicking the name of the provider or the little grey eye button to the right, should look something like this:
Once your provider record has been created, you will need to set up your GoSecure credentials.
Adding your first patients:
In order to create and submit claims, you will need to link them to a patient’s personal health number (PHN) which means that you will need to create patient demographic records in ClinicAid with your patients’ details. There are three ways to add new patients to your ClinicAid account.
Adding a patient record from the Manage Patients section:
You can add patient records by navigating to the Manage Patients section in the left-hand side menu. This will probably be the most efficient way to add a batch of patients when you first begin using ClinicAid and the account is still empty.
Step 1: Click the green “+ Add Patient” button towards the top left corner.
Step 2: Enter the patient’s data. OHIP requires all claims to contain the following basic patient information in order for them to be processed properly:
Health Number: 10 digit personal health number of the patient, as seen on their healthcare card.
Version code: the version code of the patient’s healthcare card, found on cards that have replaced a lost, stolen, or destroyed card. The version code is generally just a one or two-letter code found in the bottom right corner of the health card.
Nothing else is required by OHIP, unless billing for an out-of-province patient, but the ClinicAid system will also ask you to complete the following in order for the patient record to be set up correctly:
First and last name: enter the name of the patient.
Healthcare Type: the issuing province or territory that the patient is covered under. This field must be set as the correct province or territory for out-of-province patients.
Birthdate: although this is not mandatory to complete, ClinicAid will give an Acknowledgement message to ensure the user is aware that, if this isn’t completed, it may affect certain invoice values in ClinicAid.
In order to view the full patient demographic form, click on the “Edit” button. This will extend the form to a long-form which includes address details, default settings for a referring provider, and any default codes or admission dates you may wish to add to a patient’s record. Additional notes can be added in the Notes text field.
Step 3: Click the blue “Create patient” button to save the record once you have added all of the information you desire.
You can continue adding patient records by repeating this process.
For Reciprocal Medical Billing (RMB) claims, certain additional information must be included
and the format of the bill will change slightly. Most of this information is automatically completed
in ClinicAid based on the information saved into the patient’s record.
A date of birth must also be included in out-of-province patient records, as must their gender and full address, in order for the Ontario Ministry of Health to process the claim correctly through the national Reciprocal Medical Billing System. A claim for an out-of-province patient should look similar to the image below when viewing the Advanced tab on the Create Invoice screen.
Creating a patient record from the Create Invoice page:
You can also create patient records directly from the Create Invoice screen. This method will be particularly useful once you already have your patient files set up and are adding new patients as you are doing the billing for them (especially useful for physicians that don’t have regular patients).
When you click on the Create Invoice section in the menu, your cursor will automatically be in the Patient field. This field is a search that you can type patient names or PHNs into in order to pull up their patient record easily. However, if the patient doesn’t already exist in your system, you will need to add them.
Step 1: Click on the + icon in order to open up the “Add a new patient" window.
Step 2: From the second window “Add a new patient” you can add all the patient details manually or by adding only the Health Number and Version Code (Ver:) and clicking on “Auto-Populate” the system will auto-populate the information that is registered with the ministry. For this option, you will need to have valid GoSecure credentials.
Step 3: Click the “Create patient” button in order to save the record.
The patient’s record will now join your other records in the Manage Patients section and will be searchable for future billing.
Doing a demographic import of patient records from a previous system:
If you were billing through a different software previous to getting a ClinicAid account, it may be possible to import your patient data into ClinicAid so that you don’t have to manually enter each patient record into the system. We will need a copy of your data in a comma-separated value (CSV) format (generally an Excel spreadsheet-type format will work). Patient Importer Instructions.
If you don’t have direct access to the data, you will need to ask your current billing software provider for the export or, if the data is on a server within your office, we may be able to access it remotely.
Creating your first invoice:
There are 5 main sections to complete in order to create and submit your Ontario Health
Insurance Plan (OHIP) claims properly.
Completing the patient information section:
Step 1: Select the patient you wish to bill for. This field acts as a search so if the patient already exists in your account, simply search for them by name or PHN. If the patient does not yet exist, add the patient record following the instructions above.
Step 2: Once the patient is selected, their information should prefill in the Patient Information section of the invoice.
Step 3: Add a Referral ID if the patient was referred to you by another physician. This field acts as a search so you can begin typing the referral physician’s name or practitioner ID. If they don’t appear in the search results, you can simply type in the practitioner ID if you know it, or you can add the provider as a custom referral provider by going to the Admin section in the left-hand side menu, opening the Referral Providers tab, and adding a new referral provider.
Step 4:Completing the provider information section if you’ve set a default provider in your account, (especially useful for sole practitioners), the Provider Information section should already be prefilled. Otherwise, simply begin typing the name of the physician or select them from the list that appears.
To set a default provider, click the Edit icon next to the Default Provider setting (found at the top right of the screen next to your account information) and select the provider’s name you wish to set as the default provider in the account.
To save, click the checkmark. Once this is saved, your new invoices will have the provider
information section prefilled with the provider’s details.
Adding line items with appropriate service codes and diagnostic codes:
All claims submitted to OHIP will require a service code. Fee amounts may be modified using either the multiplier and percentage fields or using the Override Fee field. Some service codes also require a diagnostic code.
The service codes and diagnostic codes fields are searchable by code or by description so typing numbers or letters in these fields will automatically display search results. Codes can be selected from the search results or typed in.
In order to complete a line item, follow these steps:
Step 1: input the appropriate service code. Service codes generally consist of 5 characters and follow this format: A001A. You can search for a code by number or description. For longer descriptions, you can hover over the short description in order to see the full text.
Step 2: complete the multiplier and percentage increase fields, if applicable. If the fee amount claimed is different than the fee amount shown, you can indicate how much you’d like to claim for by using the Override Fee field.
Step 3: input the appropriate diagnostic code, if applicable. You can search for the code by the number of the word.
Step 4: Select the service date. By default, the service date is set to today’s date. In order to select a service date in the past, use the calendar feature.
Step 5: click the black “Add” button to add the line item to the invoice.
You can add as many line items as you’d like for a particular patient. They will be assessed by
OHIP based on the service code and service date.
Adding any additional information to the claim for a particular claim, such as visit location, service location indicator, and more can also be changed here: Ontario Advanced Invoice Creation
Saving and submitting your claims:
Once you’ve completed all of the necessary information on your claim, you are ready to send it in. You can either do so right away by clicking the green “Send Now” button at the bottom of the invoice or saving the claim by clicking the blue “Save” button and reviewing it once more before sending off your claims in a larger batch.
To send off your batch of saved claims, go to the Manage Invoices section. The “New” status (first tab) will display your new, unsubmitted claims which you can then send in a batch by checking the top checkbox (next to Service Date). This will select all of the claims visible on the page. You will get 2 options:
Option 1: Send: This will only send the invoices that have been checked off visible on your page.
Option 2: Send All: This will allow the system to submit all invoices that have been created and saved, which are not all visible on your page. When you select this option the system will ask you to confirm that you want to submit all claims in the New tab.
Once claims have been sent, they will move into the Pending tab until they are assessed by OHIP and sent back with updated statuses. You will not be able to edit claims that are pending until you receive a response from OHIP on them. If you have made a mistake you can contact your claims adjuster.
*Cut-off maybe be moved to a different date because of holidays or other factors.
Within 24-48 hours of sending claims in for assessment, we will receive the initial response file back from OHIP with updates to claims that have incorrect version codes, invalid PHNs, and other basic errors. ClinicAid will automatically update the statuses of your claims in the system as soon as we receive the remittance advice list back from the MC EDT system. Your claims will either be settled (accepted and paid in full) or will require action (rejected or underpaid). These can be found in the Manage Invoices Tabs.
You can submit claims as often as you’d like and you can use ClinicAid’s handy features, such
as favorite's lists and default invoices, to streamline your submission process.
For help with setup or questions about how ClinicAid’s medical billing software works, you can contact us and one of our support representatives will help you as soon as possible. We also have a video tutorial that you can follow along with in order to set up your account.
Contacts and additional resources:
Other useful resources include the Online Resource Manual for Physicians (for information about the various aspects of being a practitioner in Ontario), the Schedule of Benefits (for specific procedures lists and fee amounts), and the OHIP Forms section (for copies of the relevant forms required for practitioners in Ontario).