The ministry’s process for reviewing stale-dated claims has been updated to allow claims submitted within three months of the date of service that reject to an error report to be corrected and resubmitted after the three-month claims submission timeframe. This process only applies to claims for services rendered on or after April 1, 2023.
In such cases, the provider must submit supporting documentation, including a copy of their error report and claim identifying data, to demonstrate that the original claim was submitted within 3 months.
Resubmission of a previously rejected claim that is now stale dated:
- Correct all errors and resubmit the claim(s) in one single stale dated claim file via the Medical Claims Electronic Data Transfer (MCEDT). You can do this by selecting "file upload" and then the "stale dated claim file" option in the drop-down menu on the GO Secure website, or by using the appropriate option to upload a stale dated claim file in your billing software.
- Send an email to ClaimsManagement@ontario.ca including all of the following:
- Six-digit OHIP billing number and/or four-digit group number. Separate your request by physician and group. Do not send requests for different physicians in one email.
- A list of outstanding claims being resubmitted.
- Confirmation that the stale-dated claim file has been uploaded.
- Corresponding Error Reports for all claims being resubmitted for stale date processing.
Claims should be resubmitted as soon as possible after the rejection date to ensure payment of eligible claims.
Submission of stale dated claims not previously submitted
For stale-dated claims that were not previously submitted within 3 months of the service date, the process is as follows.
- The provider’s OHIP billing number and/or group number. Please note separate submissions are required for each physician or group. Do not send multiple requests in one email.
- A list of the stale dated claim(s) including the patient’s health number, fee schedule code(s) and service date(s).
- Extenuating reasons that prevented the claim(s) from being submitted within the three-month submission timeframe.
- Signature of the provider and/or group representative (billing agent and secretary signatures will not be accepted).
The stale-dated claim approval request submission will be reviewed and a response letter will be sent to the provider.
View this INFOBulletin on the MCEDT website.