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Ohip reimbursement claim form

Ohip 0031-2026

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The document is a Claim Transmittal Form used for submitting claims for reimbursement of medical expenses under Medicaid and FHPlus programs. It includes sections for recipient information, service provider details, description of services provided, dates of service, total bill amounts, and certification of eligibility for reimbursement.

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Click ‘Get Form’ to open the ohip 0031 in the editor.
Begin by entering the LOCAL DISTRICT and RECIPIENT NAME at the top of the form. Ensure that all names are spelled correctly for accurate processing.
Fill in the CLAIMANT’S SSN, which is essential for identification purposes. This should match official records.
Input the APPLICATION DATE, ensuring it reflects when you submitted your claim. This helps track eligibility periods.
Provide the RECIPIENT ADDRESS and CLIENT IDENTIFICATION NO., as these details are crucial for correspondence and verification.
List the SERVICE PROVIDER's NAME, ADDRESS, and MEDICAID PROVIDER ID#. Accurate information here ensures proper reimbursement.
Detail each DESCRIPTION OF SERVICE PROVIDED, including specifics like name, strength, and quantity for prescription drugs.
Record the DATE OF SERVICE in MO/DAY/YR format to maintain clarity on when services were rendered.
Enter TOTAL BILL amounts along with any INSURANCE PAYMENT received. This will help calculate net claims accurately.
Finally, certify your claim by signing where indicated. This confirms that all information provided is true and complete.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the code A3H for OHIP billing?

OHIP Error Code - A3H - Max Number of ser FSM ref MC For example, G512A (Palliative care) is limited to a quantity of 1 per week. Should G512A be submitted at a quantity higher than once per week, the service will be rejected with an A3H error code.

How do you know if you are covered by OHIP?

Am I eligible for OHIP? be physically in Ontario for 153 days in any 12‑month period. be physically in Ontario for at least 153 days of the first 183 days immediately after you began living in the province. make Ontario your primary residence.

What are the domains of OHIP-14?

The OHIP-14 Questionnaire consists of 7 domains, namely, functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. There are two questions in each domain. The five-point Likert scale was used for rating patients responses.

What is OHIP-14?

The 14-item Oral Health Impact Profile (OHIP-14) is the most frequently used instrument to measure oral health-related quality-of-life (OHRQoL) in adults.

How to check if OHIP is still active?

Note: If youre a patient inquiring about your OHIP health card, eligibility and/or coverage, please contact ServiceOntario at 416-314-5518 or Toll-free 1-866-532-3161 or visit for more information.

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How to interpret OHIP-14?

The OHIP-14 scores can range from 0 to 56 and are calculated by summing the ordinal values for the 14 items. The domain scores can range from 0 to 8. Higher OHIP-14 scores indicate worse and lower scores indicate better OHRQol [8].

What is the difference between OHIP 14 and OHIP 49?

The OHIP-14 which contains two items per domain as derived from the regression analysis of the original full version, OHIP-49, exhibits a high degree of resemblance and correlation with OHIP-49 [12]. However, it has higher floor effects (high degree of patients reporting no change) than the OHIP-49 [12].

What does the OHIP score mean?

The OHIP-14 is a short questionnaire that helps measure how much trouble or discomfort people have because of problems with their teeth, gums, or mouth. It asks about how these problems affect daily life. The OHIP-14 score can go from 0 to 56. To get your score, you add up the numbers from all 14 questions.