We Handle Your Entire OHIP Billing — Submissions, Rejections, Recovery, Reconciliation.
1.5% of paid claims. No platform fee. No minimums. Billing gaps can cost Ontario FHO physicians an estimated $20,000–$50,000/year in rejected claims and missed codes (based on Physicians First analysis of Ontario physician billing patterns) — our system is designed to catch these, running 674 validation checks per claim before and after submission.
No platform fee · No minimums · No setup fee · 1.5% of paid claims only
The Billing Gap Is Larger Than You Think
OHIP billing looks straightforward. In practice, the system is complex enough that most FHO physicians leave money on the table every billing cycle.
Stale dates expire at 3 months. Diagnostic codes affect your capitation acuity band. Shadow billing requires exact 30% or 50% Appendix A rates. Rejection management has hard resubmission windows. These are not details — they are where revenue is lost, quietly, every month. Our billing optimization guide covers how each of these rules affects FHO practice revenue.
Regulatory Currency
This guide reflects the following MOH INFOBulletins:
- 260309 — FHO Hourly Rate Payments (Apr 1, 2026)
- 260308 — FHO+ Implementations for April 2026 (Apr 1, 2026)
- 260304 — PSA Fee Schedule Adjustments (Apr 1, 2026)
Last verified: April 16, 2026
Everything Covered. One Fee.
At 1.5% of paid claims, you get a complete managed service — we do the work. Nothing to learn, nothing to manage, nothing to submit yourself.
Claim Preparation
AI reviews every EMR encounter, applies correct fee codes, diagnostic codes, and service dates before submission. Errors caught before they leave the clinic.
MCEDT Electronic Submission
Our system is built to submit claims through the Ministry’s MCEDT system on your billing schedule (conformance certification in progress). Confirmations tracked automatically.
Rejection Management
Every rejection investigated and resubmitted within the Ministry’s correction window. No rejected claim goes unworked. Not sure what a rejection means? Look up any rejection code →
Remittance Advice Reconciliation
Every RA matched against submitted claims. Discrepancies identified and actioned. Monthly reconciliation report delivered to you.
Stale-Date Recovery
Claims approaching the stale date are flagged using our OHIP billing cut-off dates calendar and expedited. Recoverable revenue isn’t left to expire.
Missed Code Detection
AI cross-references your encounter records against billable codes. If a billable service wasn’t billed, we flag it before the window closes.
Diagnostic Code Optimization
Diagnostic codes affect your capitation acuity band and FHO+ eligibility. We review your coding patterns and optimize for accurate acuity classification. Browse diagnostic codes →
Shadow Billing Accuracy Review
FHO shadow billing requires exact Appendix A rates (30% or 50% depending on service). We audit your shadow claims for accuracy on every cycle.
Monthly Billing Performance Reports
Clear monthly summary: claims submitted, paid, rejected, recovered, and year-over-year trends. No log-in required — delivered to your inbox.
- No platform fee
- No minimums
- No setup fee
- No long-term contract
How it stacks up
Switch from Dr. Bill Comprehensive and save $1,688/year — while catching more missed codes.
How It Works — Three Steps, Zero Workflow Disruption
We handle everything. You stay in your existing EMR and billing workflow — only the submission and management process changes.
Connect Your EMR
We connect to your EMR billing data through a read-only integration. No workflow changes for you or your staff. Setup takes one session.
We Review Every Encounter
We cross-reference every encounter against billable codes, flag missed codes, check diagnostic code accuracy, and prepare clean claims for submission — running 674 automated validation checks before anything leaves your clinic.
Submit, Manage, Reconcile
Claims submitted via MCEDT (conformance certification in progress). Rejections managed and resubmitted. RA reconciled monthly. You receive a clear performance report. Nothing falls through.
Also an FHO+ Practice?
Combine OHIP Billing with OpsMed FHO+ time capture and get loyalty pricing on both — the Complete Package.
- 1.25% on OHIP claims (vs. 1.5% standalone)
- $1.40 per FHO+ increment (vs. $1.60 standalone)
Common Questions
OpsMed covers the full OHIP Schedule of Benefits for FHO practices: FFS codes, FHO basket codes (all 119+), shadow billing, Appendix A services, and specialist referral codes. We also handle the new FHO+ time-based codes (Q310–Q313) if you’re on the Complete Package. If you have a question about a specific code, ask us in the assessment call — we’ll confirm coverage before you sign anything.
Dr. Bill Comprehensive charges 1.95%. Medical billing agencies typically charge 2%–4%. In-house billing staff cost $45,000–$70,000+ annually in salary and overhead. At 1.5%, OpsMed costs a typical FHO physician (billing $375,000/year) approximately $5,625/year — $1,688 less than Dr. Bill and with missed code detection that most competing services don’t offer. You also pay nothing until claims are paid: no platform fee, no minimums, no setup cost.
No. We run a parallel billing review in month one so you can see what we’d catch before any changes go live. You choose when to transition. We handle the timing around your existing billing schedule so there’s no gap in submissions. Your patients, your EMR, and your billing number stay exactly the same — only the submission and management process changes.
Every rejection gets a root cause review. Common causes — incorrect diagnostic codes, duplicate submission flags, eligibility issues — are corrected and resubmitted within the Ministry’s correction window (generally within 90 days of the initial submission date). You receive a rejection summary with each monthly report so you have full visibility. Rejections that can’t be recovered (e.g., legitimate duplicate billing) are flagged and documented.
We currently work with OSCAR community edition (integration tested, OSCAR Pro API access pending) and can work with any EMR that exports standard OHIP billing files. Accuro and PS Suite integrations are in development. If your EMR supports OHIP export, we can typically start within one billing cycle. Ask during the assessment call and we’ll confirm compatibility before any commitment.
All data is returned to you or securely destroyed within 30 days of cancellation — your choice. Your billing history and RA records are exported in a standard format you can import into any billing system. Patient data is stored in Azure Canada Central. AI-assisted features process only de-identified data and no customer data is used to train AI models. OpsMed acts as your PHIPA agent: your patient data is yours, always, and you retain full ownership throughout the relationship.
Why Physicians Choose OpsMed
Credibility matters when you’re trusting someone with your OHIP billing. Here’s what sets us apart.
Founded in the field
Built by people who understand clinics
Jason Lacroix, ACP, has spent years working alongside physicians in Ontario’s healthcare system. Marc Lacroix brings cybersecurity and automation expertise from CyberLeda. They built OpsMed to solve billing problems they witnessed firsthand — not from a boardroom.
Independently owned
Not bank-owned. Not hospital-owned.
Dr. Bill is owned by RBC. DoctorCare is owned by WELL Health Technologies (TSX: WELL). OpsMed is independently owned and operated in Ontario. Our only incentive is recovering every dollar your practice is entitled to — at 1.5%, competitive rates designed to undercut traditional billing services.
8,100+ curated entries
The deepest OHIP billing knowledge base in Ontario
OpsMed’s intelligence system contains 8,100+ curated data points on OHIP billing, FHO+ compensation, PHIPA compliance, and clinical documentation. Our claim engine runs 674 automated validation checks against the Schedule of Benefits before any claim is submitted. When a code question comes up, we don’t guess.
Join OpsMed’s Founding Practice Cohort
We’re recruiting our first practices now. As a launch cohort member, you get:
- Hands-on setup with Marc and Jason personally — not delegated to a junior tech
- Direct input into product development — your feedback shapes the roadmap
- 90-Day Performance Guarantee — if we don’t recover at least 3× our fees in found revenue, your billing fees are refunded
- Founding rate locked for 12 months