Page 3 of 10: Impact of Shortened 3 Month Claim Submission Timeframe on Risk of Rejection due to "Stale Dated" Claims

Dear SMPA Members,

With the reduction in the time frame from 6 months to 3 months prior to OHIP claims becoming "stale dated" (i.e. not paid by OHIP) effective since April 1, 2023, it has become more important to have your claims and billing cards submitted to the billing office in a timely manner.  This is particularly important for errors and rejections which can sometimes take one or even two monthly billing cycles to get identified, corrected, and resubmitted.  When we had 6 months prior to claims becoming stale dated, this gave us much more time to re-submit errors and rejections, however, with only 3 months the time frame for resubmissions has considerably shortened.

We would strongly encourage you to submit your claims and billing cards within a week of the date of service.  Although the billing office makes every effort to submit billing cards they receive in a timely manner, if your claims and billing cards are submitted more than a month or two after the date of service there is a significant risk that some of your claims may not be paid, particularly if there are errors or rejections requiring re-submission.

Please do not hesitate to contact us with any questions or concerns.

Best regards,