If you’re billing OHIP for a patient who holds health coverage from another Canadian province, you’ll need to follow a specific process called Reciprocal Medical Billing (RMB). Ontario’s Ministry of Health (MOH) processes out-of-province billing claims for every province except Quebec, but only if the patient’s record is set up correctly first.
This guide walks through exactly how to complete out-of-province billing in Ontario, step by step.
What Is Reciprocal Medical Billing (RMB)?
Reciprocal Medical Billing is the system that allows Ontario healthcare providers to bill a patient’s home province through OHIP when that patient receives care in Ontario. It applies to all Canadian provinces and territories except Quebec, which has its own separate billing arrangement.
Step 1: Update the Patient’s Master Record with Correct Health Card Information
Before submitting any out-of-province claim, confirm the patient’s master record contains accurate health card details. Under the health insurance section, verify:
- Health insurance number – entered exactly as shown on the patient’s card
- Health card type – set to the patient’s actual home province (not Ontario/OHIP)
This step is the foundation of accurate out-of-province billing. If the health card type and number aren’t correct, the claim won’t process as reciprocal billing.
Step 2: Create and Save the Invoice as Normal
Once the master record is updated, billing works almost identically to a standard OHIP claim. The system will still display “Bill OHIP” on screen — this is normal and expected. Simply create the invoice and save and close it the way you would for any other patient.
Step 3: Verify the Billing Was Processed as Reciprocal Medical Billing
After saving the invoice, confirm it was set up correctly:
- Return to the patient’s master record
- Open Billing History
- Select the most recent invoice and click Edit
You should see the health card type listed as the correct out-of-province jurisdiction (e.g., British Columbia), and the pay program automatically set to Reciprocal Medical Billing.
Important: Out-of-Province Health Cards Cannot Be Validated
Unlike OHIP cards, out-of-province health cards can’t be validated electronically through the system. This means it’s up to you to manually review the physical card for accuracy — including the health insurance number, card type, and expiry date — before submitting. Skipping this check is one of the most common causes of delayed or rejected reciprocal billing payments.
Quick Recap: Out-of-Province Billing Checklist
- Enter the correct health insurance number in the patient’s master record
- Set health card type to the patient’s home province
- Create and save the invoice as you would for OHIP
- Confirm billing history shows the correct card type and “Reciprocal Medical Billing” pay program
- Manually verify the health card details on the physical card
Frequently Asked Questions
Does Ontario’s OHIP bill all Canadian provinces?
Ontario processes out-of-province billing for all provinces and territories except Quebec, which uses a separate reciprocal arrangement.
Why does the system still say “Bill OHIP” for out-of-province patients?
This is normal. The invoice screen displays “Bill OHIP” regardless of the patient’s home province — the correct billing program is applied automatically based on the health card type entered in the master record.
Can I validate an out-of-province health card in the system?
No. Out-of-province cards cannot be validated electronically. You must manually check the card details to ensure accuracy before billing.
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