Ontario OHIP billing
OHIP billing by Ontario medical specialty
What gets underbilled in Ontario is rarely the main procedure. It is the premium attached to it, the consultation that was downgraded to an assessment, and the claim that was rejected once and never resubmitted. Which of those bites hardest depends on the setting you practise in, so these pages are organised that way.
Each specialty page sets out the codes and premiums that discipline commonly leaves behind, and the rejection patterns we see most often in it. If you are here because of a specific rejection on a remittance advice, the error and rejection code index is the faster route, and claims recovery covers what is still recoverable after the three-month window.
Hospital and consultative medicine
Consultation and assessment codes, ward care, and the admission data that has to line up before a premium will pay. Rejections here usually trace back to the admission record rather than the code.
Procedural and surgical
Procedure codes billed alongside assessments, assistant and anaesthesia components, and after-hours premiums. The common gap is work performed and documented but never carried onto the claim.
Community and longitudinal care
Longer consultations, time-based codes and recurring follow-up. Version codes and eligibility drift cause more rejections here than coding choices do.
Why setting changes the billing more than the specialty does
The same physician bills differently in a hospital department, a community clinic and a shared group arrangement, because the admission record, the responsible-physician designation and the submitting number all change with the setting. Two internists with identical patient volumes can see very different remittance totals for that reason alone.
For the wider picture across disciplines, see the Ontario OHIP billing hub, or billing through a hospital or group arrangement if someone else submits your claims.