Billing patients who are covered outside of Ontario can feel complex—especially when multiple programs, ministries, and workflows are involved. Whether you’re submitting Reciprocal Medical Billing (RMB) claims for out-of-province patients, managing Interim Federal Health (IFH) coverage, or preparing OHIP claim files correctly, having a clear process is essential to avoid delays and rejected claims.
OSCAR Pro supports Ontario clinics with built-in workflows designed to make out-of-province billing more efficient. In this blog, we share tips to help physicians navigate and manage out-of-province workflows in OSCAR Pro.
Understanding Out-of-Province Billing in Ontario
Ontario’s Ministry of Health (MOH) allows physicians to bill for medically insured services provided to patients from other Canadian provinces and territories, with the exception of Quebec. These claims are processed through RMB and submitted alongside regular OHIP claims.
Additionally, some patients, such as refugees or protected persons, may be covered under IFH, which follows a different billing and payment workflow.
Before submitting any out-of-province claims, it’s critical to ensure:
- Patient demographic and insurance data is entered correctly
- The correct billing program is used
- Claims are included properly in OHIP submission files or sent to the appropriate payer
Out-of-Province Billing in OSCAR Pro
For patients insured by another Canadian province (excluding Quebec), OSCAR Pro simplifies RMB billing by handling much of the setup automatically.
Key things to know:
- The patient’s Master Record must include the correct health card number and province under Health Card Type.
- Out-of-province health cards cannot be validated through Ontario systems, so staff must manually verify the card details.
- When the province is set to anything other than Ontario, OSCAR Pro automatically assigns the billing to RMB.
- Invoices are created the same way as OHIP invoices and included in the next OHIP submission after simulation and generation.
This automation helps reduce manual errors while ensuring claims are routed correctly to the MOH.
Read the full RMB Out-of-Province Billing guide and watch the walkthrough video in the OSCAR Pro Support Portal for detailed steps and screenshots.
Simulating & Generating OHIP Claim Files (Including RMB Claims)
Before any OHIP or RMB claims are submitted, clinics should always simulate their OHIP claim file. This step ensures that invoices meet formatting requirements and can be processed by the Ministry without technical errors.
Why simulation matters:
- It checks for formatting issues, not service code eligibility.
- Errors can be corrected before claims are officially submitted.
- Only invoices with a “Bill OHIP” status are included.
- A failed simulation should always be resolved before generating the final claim file.
Once the simulation passes, clinics can generate the OHIP claim file, which:
- Changes invoice status to Submitted OHIP
- Moves the file to the MCEDT Mailbox for submission
- Ensures RMB and OHIP claims are sent together correctly
This step is essential for accurate and timely reimbursement.
Explore the full OHIP simulation and file generation guide in the OSCAR Pro Support Portal to ensure your submission workflow is set up correctly.
IFH Billing in Ontario: What’s Different?
IFH billing applies to patients who are not yet eligible for OHIP but receive coverage through the federal government, administered by Medavie Blue Cross.
Unlike OHIP and RMB billing, IFH claims are not submitted to the Ontario MOH.
Key IFH billing considerations:
- IFH must be added as an Enrollment Status in the patient’s Master Record.
- The patient’s IFH insurance number should be entered accurately.
- Invoices must be created with the Billing Type set to IFH.
- Claims are submitted directly to Medavie Blue Cross, not through MCEDT.
- Payments are tracked and applied using Invoice Reports in OSCAR Pro.
OSCAR Pro provides reporting tools to help clinics monitor payments, outstanding balances, and settlement status for IFH invoices.
Read the full IFH Billing guide in the OSCAR Pro Support Portal to learn how to create, track, and settle IFH invoices efficiently.
Best Practices for Out-of-Province Billing
To reduce rejections and delays, Ontario clinics should follow these best practices:
- Always verify health card details manually for out-of-province patients.
- Use OHIP simulation reports regularly to catch errors early.
- Understand which payer each claim should be submitted to (MOH vs. Medavie).
- Leverage OSCAR Pro’s automated billing logic instead of manual workarounds..
- Train staff using official OSCAR Pro videos and support articles.
Learn More in the OSCAR Pro Support Portal
Out-of-province billing doesn’t have to be overwhelming. OSCAR Pro’s Support Portal includes detailed articles, videos, and step-by-step instructions to help Ontario clinics stay compliant and get paid accurately.
Visit the OSCAR Pro Support Portal to read the full resources on RMB billing, IFH billing, and OHIP claim file submission—and empower your billing team with the tools they need to succeed.