Ministry Issues Reminder to Validate Health Cards at Every Patient Visit

TORONTO — The Ministry of Health is reminding all Ontario healthcare providers to validate patient health cards during every visit, emphasizing the importance of using the Health Card Validation (HCV) service to confirm patient eligibility at the point of care. Echoplex Healthcare Solutions Inc. supports this initiative to ensure accurate billing and reduce claim rejections for providers across the province.

Key Reminders for Providers:

• Always request and validate the most up-to-date health card from patients at every visit.
• Validating health cards helps prevent claim rejections caused by patient ineligibility.
• Cards that pass validation will receive a response code between 50 and 55 from the HCV system. These can proceed with standard OHIP claim submission processes.

When a Health Card Fails Validation:

• Review the data for possible input errors.
• Reconfirm the health number and version code with the patient.
• Ask if the patient has received a newer health card.
• Advise patients to contact ServiceOntario to update their information.

If a valid health card cannot be produced at the time of service, providers may charge the patient directly. However, if the patient is later confirmed as eligible for OHIP on the service date, they may return to request a reimbursement.

Legal Compliance – A Critical Reminder:

Under the Commitment to the Future of Medicare Act (CFMA), it is illegal to charge patients for OHIP-insured services. This includes:

• Extra billing for any insured services or service components
• Charging for expedited or “queue-jumping” access
• Requiring payment for uninsured services as a condition for receiving insured care (e.g., block fees)

Violations of these rules may lead to enforcement actions. Providers are encouraged to review both the Health Insurance Act (HIA) and the CFMA via ontario.ca/laws for more information.

Managing Rejected Claims:

Claims denied due to invalid health information can be resubmitted once the patient provides an updated and valid health card.

For complete guidance, healthcare providers should refer to the Health Card Validation Reference Manual.

Echoplex Healthcare Solutions remains committed to supporting providers in maintaining compliance and streamlining their billing practices. For additional assistance, please contact our support team or consult your software documentation for HCV integration best practices.