How To’s

Agent+ How-To’s

General

How to make a claim
STEP 1
Start from the home screen, tap “New Claim”
STEP 2
Quickly add patient information using one of three methods:

  1. Use the scanner to capture the patient label (Pro Tips: avoid any shadows on your labels, give the camera time to focus fully, and allow the scanner time to add a box around the health card number)
  2. Tap “Use Existing” to use a patient you have already entered into the app
  3. Tap “Skip” on the top scanning screen, and directly enter the patient’s health card number
STEP 3
In both cases the Health Card Validation will verify the patient’s information with the Ministry of Health, and ensure all information is correct
STEP 4
Tap “Next” to continue and add your patient’s visit information
STEP 5
Tap “Next” to start claiming services
STEP 6
From the Claim Info screen, you can start adding service codes to the claim. You can also return to and edit patient information and visit information by tapping on their boxes. To add a service, tap the “Add Service” row, which will bring you to the service selector where you can select all applicable service codes
STEP 7
Once you have selected your codes tap “Add” to add them to your claim
STEP 8
Adding codes will return your to the Claim Info screen. From here you may be presented with code suggestions based on our algorithms, and you have the opportunity to add documentation to your claim
STEP 9
Tap “Save” to save your claim. Your claim can now be found by visiting Claims Management from the home screen.
Scanning patient labels
Agent+ had developed a unique combination of scanner and health card validation to make patient entry a breeze. The advantage of this system, is that as long as the health card number is present, health card validation verifies the health card is correct and fills in any missing or incorrect information.
Tips for getting the best results from the scanner.

  1. Make sure there are no shadows on the label
  2. Allow the “red boxes” to find and enclose the important pieces of information, particularly the health card number
  3. Hold your phone parallel to the label. If your phone is on a flat surface, you can line up your phone using the crosshairs.

If you’re encountering problems with the scanner not reading your labels properly, you have a few options

  1. Try scanning exclusively the health card number. This often helps the scanner read more easily, the health card validation takes care of the rest of the details
  2. Manually enter the health card number, and let health card validation fill in the rest of the details
Submit a Claim
When you have completed a claim, you submit it to the Ministry of Health for payment. Once submitted, claims can no longer be edited.

To submit claims:

STEP 1
Go to the Ready folder from Claims Management. Tap the checkbox beside each claim you wish to submit
STEP 2
Tap “Select All” to select all claims at once. Note that claims can no longer be edited once they have been submitted
STEP 3
Once you have selected all claims you wish to submit, tap “Submit Claims”
STEP 4
Wait for the claims to upload
STEP 5
Once all claims are uploaded, you can see a summary of how many you have submitted, and how much they totalled
How does health card validation work?

Once you have scanned the health card number and version code, you will be on the ‘Patient Info’ screen.  While the health card is checking for validation by cross referencing the Ministry of Health (MOH) patient database, you will see the message “Verifying patient details with MOH”. This feature is most effective when claims are being created in real time because it is checking the current MOH patient database.

If the health card number matches one from the MOH database, the patient demographics will automatically populate.  You must be connected to LTE or wifi to use this feature. If you create the claims without an internet connection, the claims will go through the health card validation process once you are reconnected to wifi or LTE, and have the app open.  To avoid unnecessary rejections, we recommend all claims go through health card validation and the validation message be reviewed before submitting a claim.

For further clarification on any of the return messages, please review below:

Patient details verified. Tap here to re-verify and reset patient info – The health number and version are correct.

Version code incorrect. Tap here to re-verify and reset patient info – The version code is incorrect. Check that the version code scanned correctly.

Patient cannot be verified because of an error with the health card number – The health number does not match a health number in the MOH patient database. Check that the health number scanned correctly.

This health card number is ineligible for service – The health number no longer has OHIP coverage, the patient needs to be contacted to resolve the issue.

My referring physician is not in the database. How do I add them?
Agent+ is continually growing the list of referring physicians in our database. Despite this, we don’t have every doctor in our database.

To add and use a referring physician first go to the referring physician list by tapping the “Referring MD” field inside of the Visit Information screen.

Ensure that the doctor isn’t already in the database by searching for their name. If there are no results, tap “Add Referring Doctor”

This will give you the ability to add a new referring doctor into our database by entering the new doctor’s Name and MOH Billing number

Tap “Add” select the doctor for that visit, and save the entry for future use.

There are two referring physicians with the same name. How do I know which is correct?

The Referring Physician list is compiled from users.  If there are 2 referring physicians with the same name, you must verify with the physician or the hospital database.  If you learn one of the physicians in our database is incorrect, kindly advise us so we can have the database updated to avoid similar confusion for yourself and other users in the future.

Pro Tip: Tap the star to the left of the physician to save a physician as a favourite.

How to use Facility Search and Favourites
There are thousands of facilities available in Ontario, and finding the right one is important.

STEP 1
Enter your facility keywords. For example, searching for a facility at North York General Hospital, you could type in “NYGH” or “North York”. If you know the ID number for the facility you are looking for, you can also search for that directly
STEP 2
As you start typing your search keywords, the list of facilities will automatically start filtering to match your criteria
STEP 3
Look at the main facility name as well as the smaller description of the facility. For example, searching “NYGH” brings up five possible facilities, each with a more detailed description of the type of facility, to help you choose the right one
STEP 4
Tap to select
STEP 5
Tap to select

Pro Tip: Easily toggle between your commonly used facilities by tapping the star to the left of the facility so it will always appear at the top of the list.

Customize your Diagnosis Code Favourites
You can customize your diagnosis code lists which are automatically generated by specialty by viewing the service codes in a list format.  To add or remove diagnosis code from your saved list, tap the star to the left of the diagnosis code description.
How to flag a claim for manual review by MOH?
On the ‘Claim Info’ screen, tap ‘Add Item (optional)’ to flag for manual review.  Tap on a fee service code to review comments for the Ministry that will be provided by letter or attach documentation by photo.
Delete a claim

A claim can only be deleted when it has not yet been submitted to the Ministry.  To delete a claim from your Ready or In Progress folder, swipe left over the claim.

Edit a claim after it has been submitted
Generally, you cannot edit a claim after it has been submitted.  Email support@agentplus.ca and we will correct the claim if it has not yet been sent to the Ministry of Health.

If the claim has sent to the Ministry, there is a possibility it will return as a Rejection at which time it can be corrected. If not, you can submit an RA Inquiry once the claim has returned on a Remittance Advice.

Fee Service Codes How-Tos

Select a Fee Service Code
Service codes represent the procedures, consultations, etc that you deliver and need to bill the Ministry of Health for. Agent+ works to make the long and complex list of service codes easy for fast billing.

In the first tab of the service code selector, we have hand-picked a list of commonly used codes for each specialty, as well as key sub-specialties like critical care, so you see the codes that you need

At the top of the screen you will see the specialty that is currently in use. It will automatically default to your specialty, and you can tap this row to switch specialties at any time

The main function of the service selector is the service code grid/list view. In this view you can find a collection of the commonly-used codes for your specialty presented in either list view or grid view

You can tap the bottom-left icon to switch between the list view (where shorts descriptions accompany each code), and grid view (for experienced billers who know all the codes they need)

Tap on a code to select it, and tap it again to de-select it

Long press on a code to view the full description and details from the Schedule of Benefits

View Fee Service Code lists for multiple specialties
When selecting a fee service code from the list screen, tap on the arrow to the right of the Specialty. Tap edit in the upper right hand corner to add or remove as many specialty lists as you require so you can easily toggle between all of the lists you use.
Use favourite features
The second tab found in the Service Code Selector, the Favourites list is self-curated by you, letting you add your unique favourite codes or common groupings of codes to a claim with one tap.

To create a favourite code or grouping of codes:

STEP 1
Select the service code(s) you wish to favourite
STEP 2
Next tap the Star icon beside your selected services
STEP 3
You will be prompted to create a name for your new favourite. Make sure it is unique and easily identifiable
STEP 4
Tap save to finish creating the favourite. It can now be found in the favourites tab
Select a special visit premium
The third tab in the service code selector, this is a list of premium codes related to time and location of patient visits. Have a look and see if any SVP’s apply to your claim.

For more information on how to bill Special Visit premiums, see our Resources: Special Visit premiums.

Search fee service codes
If you cannot find a service code that you are looking for, you can search for it in the fourth and last tab in the service code selector.

To search:

STEP 1
Start typing in keywords for the service you are looking for. If you know the specific code you need, you can also search for that directly. As you start typing your search keywords, the list of services will automatically start filtering to match your criteria
STEP 2
You can refine your search results by tapping the “Filter Results” button near the top of the screen. All results are presented by default, but by changing the filter you can filter your search results by a specific specialty
STEP 3
Tap a code to select
Bill a code that has basic units and time units

Step 1: Select the procedure code (Surgical Assist B suffix OR Anesthesiology C suffix)

Step 2: Under the Start & End Time field, tap ‘>’ to calculate the time units

Step 3: Enter start time and end time of the procedure

The app software automatically calculates the time units for the procedure, which shows in the ‘Start & End Time’ field.  The $ value showing beside the fee service code calculates the total value of the claim including basic and time units.

Bill second surgical procedure at 85%

From Surgical Preamble on page SP2 in the Schedule of Benefits: When a subsequent non-elective procedure is done for a new condition by the same surgeon, the full benefit will apply to each procedure. When a subsequent elective procedure is done for a different condition within 14 days during the same hospitalization by the same surgeon, the benefit for the lesser procedure shall be reduced by 15%. 

Step 1: In Settings, ensure your Professional Profile has General Surgery selected as a specialty

Step 2: Select the procedure code (General Surgery A suffix code)

Step 3: Tap on the 100% on the right side of the fee service for the option to switch the code to an 85% value

Submit a claim with more than 99 units

The maximum units that MOH will accept for a given fee service code is 99 units.  If you performed a service that equates to more than 99 units, you should submit the claim with manual review and provide a letter explaining the length of the surgery and the reason you need to submit the claim with greater than 99 units.

Using Rounds Feature

About Rounds feature
Our rounds feature has been built to make billing easier for doctors visiting the same patient repeatedly. Agent+ solves the problem of constantly duplicating information when billing for rounds patients by creating a rounds list that does the work for you, just add services provided for each day and submit.

Add a patient to your rounds list by tagging them as a rounds patient in the visit information screen. Once a patient is tagged, they will appear in your rounds list until you remove or discharge them

The rounds feature works like a checklist for each day. All patients currently admitted and tagged as rounds will appear on your list, organized by facility, for every day that they have been admitted

By changing the date at the top of the rounds screen, you can see your rounds list for days in the past, and back-bill rounds visits easily

Rounds also provides you with a history of the claims you have submitted for each patient. To see this list, tap the patient’s name. This will show you a summary of all claims for that patient

Add a rounds visit
To check off a visit for a rounds patient, tap the empty circle beside their name

This will bring you to a pre-populated claim for the patient for that day. From this screen you can tap the “Add Service” bar to add services. For more information about adding services, consult the above how-to

Once you are happy with the services you have added, tap “Save”, which will move the claim to the Ready to Submit folder, and return you to the rounds list

Remove a patient from your rounds list
To remove a patient from the list, swipe along their name from right to left. This will reveal the option to remove or discharge. Tapping “Remove” will simply take the patient off your list from that day forward. Tapping “Discharge” will automatically bring you to a claim where you can add the discharge service codes. Discharging a patient will remove them from your list starting the next day.

Managing Your Claims

Understanding your Manage Claims screen
You should always know at what stage of the billing process your claims are at. That’s where Claims Management comes into play.

From the home screen, tap the “Manage Claims” button

This will bring you to the hub of the app where you can find every claim you’ve created using Agent+

At the very top is an overview of how much you have claimed for the past three months. Tapping on this area reveals the dollar value of your claims for each month

Below this is the system of “folders” based on claim status In Progress, Ready, Submitted, Rejections, Partial & Non-Payments, and Resolved. See full details about these folders below.

Claims in the In Progress folder
The In Progress folder contains any claim that you have created, but that doesn’t contain all information required to submit.

If you are unsure what information is missing, check that all visit information is present, and that a valid health card number and the gender of the patient have been completed (health card validation will fill in the rest of the information)

Claims in the Ready folder
The Ready folder contains claims that are ready to be submitted. Any claim with all required fields completed can be found here.
Claim in the Submitted folder
The Submitted folder contains all claims that have been submitted, but have not yet received a response from the Ministry of Health. It has been sub-divided between claims that are being submitted for the first time, and claims that are being re-submitted due to rejection

Tap on a claim to view its details. These claims can no longer be edited

Dealing with Rejections
Claims that go to your Rejections folder have failed an initial review by the MOH. For these claims – we like to call them Level One Rejections – you can choose to address the problems with the claim and resubmit, or write off that claim and receive no payment.

To address the claim:

STEP 1
Tap a claim to view it and see the details of the error
STEP 2
Tap the “Edit Claim” button
STEP 3
You will be presented with a claim info screen, where you have the opportunity to make any change in order to resolve the issue causing the rejection
STEP 3
Once you have finished making changes, tap “Submit”. Your claim will be sent to the Ministry of Health for review.

To write off the claim:

STEP 1
Tap a claim to view it and see the details of the error
STEP 2
Tap “Write Off”. The claim will be moved to the Resolved folder.
Dealing with Partial & Non-Payments
Claims that go to your Partial & Non Payments folder have been marked with error(s) by the MOH on a Remittance Advice resulting in non-payments, or partial payments for the claim. For these claims – we like to call them Level Two Rejections – you can choose to address the error by creating an inquiry and providing a reason you should be paid and documentation, or write off that claim and accept the payment as is.

STEP 1
Tap the partially or un-payed claim to view it and details about the error
STEP 2
Tap “Submit Inquiry” in order to begin creating a Remittance Inquiry to address the partial payment. You will see a summary of your original claim information, as well as an empty list of “Codes on Inquiry” and a list of “Service Codes”. The “Service Codes” are the ones originally claimed by you
STEP 3
Tap to select a service code that you would like to add to the inquiry
STEP 4
You will be prompted to add further details about that code, including the reason (underpayment vs. overpayment), a place to type an explanation for the inquiry on the code, as well as an opportunity to add documentation by taking a photo of your notes on your phone
STEP 5
Once you are satisfied with the details about the code, tap “Save” to add the code to your Remittance Inquiry
STEP 5
This process can be repeated for as many codes as you want the Ministry of Health to reconsider their payment for
STEP 6
Once all desired codes are added to your Remittance Inquiry, tap “Submit” in the top right corner of the screen. Your Inquiry will be sent to the Ministry of Health for review.
Writing off a claim
You decide NOT to challenge a claim a Rejection or Partial & Non-Payment and accept the payment as is (which may be partially or fully unpaid).
Claims in the Resolved folder: viewing your Remittance Advice in the app
The Resolved folder is where all claims are stored once they have been resolved either by payment in full, or being written off by you. Claims are sorted by RA date

Tap on a claim to view its details. These claims can no longer be edited

Submitting claims for patients not covered by OHIP

Create third party claims

Submit third party claims changing the Insurance Provider on the ‘Patient Info’ screen to ‘Third party – private billing’.  These claims are processed by our billing agent team in the background.

Attach documentation in ‘Ministry Review’ on the ‘Claim Info’ screen.  Tap on any of the service codes and attach a photo and any comments you would like to provide to the billing agent.

Depending on the type of third party claim, different information may be required:

IFH (Interim Federal Health)Blue Cross coverage for Canadian residents with a refugee status

Veterans, Armed Forces & RCMP – Blue Cross Out-Patient Claim Form and Blue Cross Hospital In-Patient Claim form

UHIP (University Health Insurance Plan)Sunlife coverage for university students subsidized by the Ontario government

Private Insurance coverage worldwide – attach signed insurance form of given insurance provider

Private Billing (bill patient directly) – include patient’s name and mailing address in patient label photo or Ministry Review

You can expect payment for third party claims by a cheque in the mail, unless you signed-up for direct deposit with the company or organization providing payment. For third party billings, it is typical for processing to take a few months depending on the insurance provider.

Download the Blue Cross form for direct deposit on armed forced and IFH claims.

For more information on billing third party claims, see OMA’s Physician’s Guide to Uninsured Services.

Create Out of Province Reciprocal Medical Billing (RMB) claims (excluding Quebec)

Submit out of province claims for payment through Reciprocal Medical Billing by changing the Insurance Provider on the ‘Patient Info screen’ for the following provinces:

  • Alberta – AHCIP
  • British Columbia – MSP
  • Manitoba – MHSIP
  • New Brunswick – Medicare
  • Newfoundland & Labrador – MCP
  • Northwest Territories – HSS
  • Nova Scotia – MSI
  • Nunavut – MSI
  • Outaouais Region – PQ
  • Prince Edward Island – Health PEI
  • Saskatchewan – Saskatchewan Health Services
  • Yukon – YHCIP

Claims are sent to the Ministry of Health and processed the same as an OHIP claim. Similarly, the claim is returned for payment on the monthly Remittance Advice and claim value is included in the cheque amount deposited directly to your account.

Please note the following services are excluded from RMB payments and should be billed directly to the patient by private billing

  • Surgery for alteration of appearance (cosmetic surgery)
  • Sex reassignment surgery
  • Surgery for reversal of sterilization
  • Routine periodic health examinations including routine eye examinations
  • In-vitro fertilization, artificial insemination
  • Lithotripsy for gall bladder stones
  • Treatment of port wine stains on other than the face or neck, regardless of the mode of treatment
  • Acupuncture, acupressure, transcutaneous electro-nerve stimulation (TENS), moxibustion, biofeedback, hypnotherapy
  • Services to persons covered by other agencies (e.g., Armed Forces, Workplace Safety and Insurance Board, Department of Veterans’ Affairs, Correctional Services of Canada [Federal penitentiaries])
  • Services requested by a third party
  • Team conference(s)
  • Genetic screening and other genetic investigation, including DNA probes
  • Procedures still in the experimental/developmental phase
  • Anaesthetic services and surgical assistant services associated with all of the above
  • Services required by the Ministry of Community and Social Services and the Ministry of Attorney General or the Solicitor General
  • PET scans and Gamma Knife Radiosurgery
  • Telemedicine services
  • Note: The patient may be eligible for direct reimbursement by his or her own provincial/territorial plan.
Submitting Quebec claims

The best way to submit a patient from Quebec’s Reciprocal claim depends on where the patient resides:

  • Outaouais Region – PQ

If the patient resides within the Outaouais Region, the claim can be submitted electronically.  Change the Insurance Provider on the ‘Patient Info’ screen to Outaouais Region – PQ.

  • The rest of Quebec – RAMQ

To have the claim paid through RAMQ, the Quebec Ministry now requires you have the patient fill out the “Out of Province Claim for Physician Services” form at the time of the patient visit. The original copy of the form must be mailed within 90 days to the following address:

Quebec Claim Office

Ministry of Health
75 Albert St. 7th Floor
Ottawa, ON K1P 5Y9

Link to the form

Please note the following services are excluded from RMB payments and should be billed directly to the Quebec patient by private billing (the following services may also not be covered by OHIP)

  • Surgery for alteration of appearance (cosmetic surgery)
  • Sex reassignment surgery
  • Surgery for reversal of sterilization
  • Routine periodic health examinations including routine eye examinations
  • In-vitro fertilization, artificial insemination
  • Lithotripsy for gall bladder stones
  • Treatment of port wine stains on other than the face or neck, regardless of the mode of treatment
  • Acupuncture, acupressure, transcutaneous electro-nerve stimulation (TENS), moxibustion, biofeedback, hypnotherapy
  • Services to persons covered by other agencies (e.g., Armed Forces, Workplace Safety and Insurance Board, Department of Veterans’ Affairs, Correctional Services of Canada [Federal penitentiaries])
  • Services requested by a third party
  • Team conference(s)
  • Genetic screening and other genetic investigation, including DNA probes
  • Procedures still in the experimental/developmental phase
  • Anaesthetic services and surgical assistant services associated with all of the above
  • Services required by the Ministry of Community and Social Services and the Ministry of Attorney General or the Solicitor General
  • PET scans and Gamma Knife Radiosurgery
  • Telemedicine services

Note: The patient may be eligible for direct reimbursement by his or her own provincial/territorial plan.

Why does my out of province claim not validate?

Health card validation is a feature offered for Ontario health cards only.

Register for Medavie Blue Cross

Claims for patients with coverage through Federal Programs such as the mohCanadian Armed Forces (CAF) and Interim Federal Health program (IFHP) for refugees are processed through Medavie Blue Cross. To manage these claims (e.g. check on the status of payment), you must register for Medavie Blue Cross. Register at this link or by mailing in this form.

To sign up for direct deposit for claims payments, click here.

Pro Tip: When asking for your License / Register Number, as a ‘Medical Services (Doctor), the License / Registration Number is referring to your 6 digit OHIP Billing #.

Create claims for Workplace Safety Insurance Board (WSIB) coverage

Submit WSIB claims by changing the Insurance Provider on the ‘Patient Info’ screen to ‘WSIB – WCB’.

Claims are sent to the Ministry of Health and processed the same as an OHIP claim. Similarly, the claim is returned for payment on the monthly Remittance Advice and claim value is included in the cheque amount deposited directly to your account.

Please note that only certain fee service codes can be claimed under WSIB coverage including: A008, K050, K051, K052, K057, K058, K059, K060, K054, K055, K056, K053, K065, K066, K061, G153, G154.  For further detail, please refer to the Schedule of Benefits page A6 and Appendix F.