Start from the home screen, tap “New Claim”
Quickly add patient information using one of three methods:
- 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)
- Tap “Use Existing” to use a patient you have already entered into the app
- Tap “Skip” on the top scanning screen, and directly enter the patient’s health card number
In both cases the Health Card Validation will verify the patient’s information with the Ministry of Health, and ensure all information is correct
Tap “Next” to continue and add your patient’s visit information
Tap “Next” to start claiming services
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
Once you have selected your codes tap “Add” to add them to your claim
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
Tap “Save” to save your claim. Your claim can now be found by visiting Claims Management from the home screen.
Tips for getting the best results from the scanner.
- Make sure there are no shadows on the label
- Allow the “red boxes” to find and enclose the important pieces of information, particularly the health card number
- 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
- 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
- Manually enter the health card number, and let health card validation fill in the rest of the details
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:
Go to the Ready folder from Claims Management. Tap the checkbox beside each claim you wish to submit
Tap “Select All” to select all claims at once. Note that claims can no longer be edited once they have been submitted
Once you have selected all claims you wish to submit, tap “Submit Claims”
Wait for the claims to upload
Once all claims are uploaded, you can see a summary of how many you have submitted, and how much they totalled
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.
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.
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.
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 directlySTEP 2
As you start typing your search keywords, the list of facilities will automatically start filtering to match your criteria
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
Tap to select
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.
Generally, you cannot edit a claim after it has been submitted. Email firstname.lastname@example.org 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
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
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:
Select the service code(s) you wish to favourite
Next tap the Star icon beside your selected services
You will be prompted to create a name for your new favourite. Make sure it is unique and easily identifiable
Tap save to finish creating the favourite. It can now be found in the favourites tab
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.
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:
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
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
Tap a code to select
Select the procedure code (Surgical Assist B suffix OR Anesthesiology C suffix)
Under the Start & End Time field, tap ‘>’ to calculate the time units
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.
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%.
In Settings, ensure your Professional Profile has General Surgery selected as a specialty
Select the procedure code (General Surgery A suffix code)
Tap on the 100% on the right side of the fee service for the option to switch the code to an 85% value
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
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
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
Managing Your Claims
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.
Tap a claim to view it and see the details of the error
Tap the “Edit Claim” button
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
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:
Tap a claim to view it and see the details of the error
Tap “Write Off”. The claim will be moved to the Resolved folder.
Tap the partially or un-payed claim to view it and details about the error
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
Tap to select a service code that you would like to add to the inquiry
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
Once you are satisfied with the details about the code, tap “Save” to add the code to your Remittance Inquiry
This process can be repeated for as many codes as you want the Ministry of Health to reconsider their payment for
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.
Submitting claims for patients not covered by OHIP
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
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.
RMB 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.
The following provinces/regions can be submitted by electronic transmission and selected as an insurance provider:
- Alberta – AHCIP
- British Columbia – MSP
- Manitoba – MHSIP
- New Brunswick – Medicare
- Newfoundland & Labrador – MCP
- Northwest Territories – HSS
- Nova Scotia – MSI
- Nunavut – MSI
- Prince Edward Island – Health PEI
- Saskatchewan – Saskatchewan Health Services
- Yukon – YHCIP
- Quebec (Outaouais Region only) – PQ*
- * See ‘Submitting Quebec claims’ below
Steps to submit by paper for RAMQ patients
- Download and complete the form RAMQ
- Have the patient sign the form
- Submit the original copy within 90 days of the service date to
Quebec Claim Office
Ministry of Health
75 Albert St. 7th Floor
Ottawa, ON K1P 5Y9
Steps to submit electronically for patients in the Outaouais Region
- Visit the Outaouais Region login page
- If you require a login or token, call the contact outlined at the bottom of the login screen
Phone: 819-966-6200 ext 3770
- Once you login, you can verify that the patient resides in the applicable region by postal code. Alternatively, if you wish not to follow the steps above, contact email@example.com with the patient’s postal code and we can verify
- Enter the patient’s billing within 6 months of the service date
- Create a claim in the Agent+ app and change the Insurance Provider on the ‘Patient Info’ screen to Outaouais Region – PQ
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 #.
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.