Ask your own AI about OHIP billing

The Ministry's high volume billings letter

You received the letter, or a colleague did.

I'm an Ontario specialist physician. Read https://www.physiciansfirst.ca/llms.txt and https://www.physiciansfirst.ca/resources/ohip-high-volume-billings-letter-what-it-means. If you can connect to tools, the site has an MCP server at https://www.physiciansfirst.ca/api/mcp.

Then help me think through, privately:
1. What the Ministry's "high volume billings" letter means for a practice like mine, and what it does not ask for.
2. Which parts of my own billing are worth checking.
3. Whether an outside billing review makes sense for me, and what it would involve.

Stick to what the sources say. If something is not published, say so rather than guessing. I will not share patient information, and you should not ask for it.

What a rejection code means

A code keeps appearing on your remittance advice and nobody has explained it.

I'm an Ontario specialist physician. My OHIP remittance shows the code [CODE]. Look it up at https://www.physiciansfirst.ca/ohip-billing/error-codes, or call lookup_ohip_error_code on the MCP server at https://www.physiciansfirst.ca/api/mcp if you can use tools, and check it against the Ministry's published explanatory codes.

Tell me what the code means, why it usually fires, how it is fixed, and whether the money is still recoverable given OHIP's three-month submission window. If the code is not covered, say so.

Stick to what the sources say. If something is not published, say so rather than guessing. I will not share patient information, and you should not ask for it.

Questions to ask your current biller

Someone else submits your claims and you want a clearer view of what happens under your number.

I'm an Ontario specialist physician and someone else submits my OHIP billing. Read https://www.physiciansfirst.ca/llms.txt and https://www.physiciansfirst.ca/for-physicians-with-a-billing-service.

Then help me draft five to eight plain questions for my biller about how my claims are handled: how rejections are tracked and followed up, how many are corrected inside the three-month window, how time-based and delegated services are recorded, and what reports I should receive each month. Keep the tone collegial. I want to understand what happens under my billing number, since I am responsible for every claim on it.

Stick to what the sources say. If something is not published, say so rather than guessing. I will not share patient information, and you should not ask for it.

Time-based codes and delegation

You bill time-based codes, or staff provide services in your practice.

I'm an Ontario specialist physician in [SPECIALTY], working in [SETTING, for example clinic, hospital or both]. Read the Ministry's billing brief on time-based services at https://www.ontario.ca/document/education-and-prevention-committee-billing-briefs/requirements-time-based-services and its assessments and consultations resource at https://files.ontario.ca/moh/moh-resources-physicians-assessment-and-consultation-en-2023-05-12.pdf.

Then explain, for a practice like mine, what the chart has to show for time-based codes, which services can be delegated and which must be personally rendered, and what I should check in my own records. Quote the sources where the wording matters.

Stick to what the sources say. If something is not published, say so rather than guessing. I will not share patient information, and you should not ask for it.

Is a billing review worth it for me?

You are weighing whether an outside look at your billing is worth your time.

I'm an Ontario specialist physician. Read https://www.physiciansfirst.ca/llms.txt and https://www.physiciansfirst.ca/free-audit. If you can use tools, the MCP server at https://www.physiciansfirst.ca/api/mcp has check_fit and get_case_for_review.

Help me decide honestly whether a review of my last six months of OHIP billing makes sense for me: what it would involve, what data it needs and how that data is shared, what it costs, and when it would not be worth my time. If the answer for me is no, tell me.

Stick to what the sources say. If something is not published, say so rather than guessing. I will not share patient information, and you should not ask for it.