How to send an OHIP claim file through MCEDT

MCEDT (Medical Claims Electronic Data Transfer) is how claim files reach OHIP and how OHIP's reports come back. If your billing software sends claims for you, it's using MCEDT behind the scenes. If you have a claim file of your own, you send it through MCEDT yourself, and it takes two steps, not one.

What a claim file is

A claim file is a plain-text file in the ministry's fixed format: a batch header, then each claim with one line per service, then a trailer that counts what came before. Every record is exactly 79 characters long. It isn't meant to be opened or edited by hand, and changing one character can get the whole file refused.

The file name is part of the format too. It starts with H, then a letter for the month, then the billing or group number, then a three-digit sequence, for example HA123456.001. Don't rename it.

Before you send it

OHIP rejects claims for missing details far more often than for clinical reasons. Check every claim in the file for:

• The patient's health number, and the version code if one is printed on the card.
• The patient's date of birth. It's mandatory on every claim.
• A service date within the last three months. Past that, the claim is stale-dated (see OHIP claim deadlines).
• The referring physician's billing number on a consultation.
• A diagnostic code wherever the fee code needs one.
• Your own details: billing number, specialty, and group number if you bill under a group.
• No visit that has already gone out in another file. A second claim for the same visit is a duplicate, and comes back as one.

The ministry recommends keeping a batch to no more than 500 claims, because one bad record can send back the whole batch.

Sending it, step by step

1. Sign in to MCEDT with your usual ministry account.
2. Upload the file as a claims file. MCEDT checks the format as it uploads. A file whose records aren't the right length, or whose trailer doesn't match its contents, is refused at this point.
3. Submit it. This is the step people miss. An uploaded file sits in MCEDT, unsent, until you submit it. While it's only uploaded you can still delete it.
4. Mind the cut-off. Files received by 5:00 p.m. Eastern on the 18th are normally processed in that month's payment cycle. If the 18th falls on a weekend or holiday, the cut-off moves to the next business day.

Send each file once. Uploading and submitting the same file again bills the same visits again.

What comes back

Reports wait in MCEDT for you to download them, and stay there for 12 months. If no Batch Edit report appears, OHIP didn't receive the batch, and the three-month clock is still running.

A rejected claim can be corrected and sent again, but the clock still runs from the original service date. Error Report vs. Remittance Advice explains how to read the codes and which rejections are worth correcting.

Building the file in Med Copilot

Med Copilot's Claims screen builds this file from the visits you've recorded. It checks every claim against the list above, shows how many days each one has left, takes the fees from the ministry's Fee Schedule Master, and won't put a visit in two files. You review each claim and attest once per batch, then upload and submit the file on MCEDT yourself: Med Copilot never sends anything to the ministry. When the Batch Edit report or Error Report comes back, upload it to Med Copilot and each claim is marked accepted or rejected. It covers office and home visits; hospital, emergency department and long-term-care visits, and split-fee codes, still go through your usual channel. See how it works.

This guide summarises ministry publications, including the MCEDT Reference Manual and the claims interface specification, for convenience. The ministry's own documents are authoritative.