New Primary Care OHIP Payment and Roster Report

The Ministry of Health and Long Term Care (MOHLTC) recently started delivering OHIP Payment Summary (Payment) and OHIP Roster & Capitation Payment Reconciliation (Roster) reports via their MC EDT interface. The MC EDT interface provides a PDF version with a corresponding XML version for the same Payment or Roster report. The contents of the 2 files are the same - they are just formatted differently. The XML formatted version of the file provides a way of extracting data from the reports and using it in a meaningful way. Indivica OSCAR has been improved to process and display the new reports with the following features:

*   PDF files can be displayed from the View MOH Files Inbox

*   PSX (Payment) group XML files can be displayed from the VIEW MOH Files Inbox

*   RCX (Roster) solo and group XML files are processed to update patient demographic record with ministry roster information

These files are automatically sent to your View MOH Files Inbox if you are registered with Indivica's WebEDT service.

Manual Upload

If you manually download your MC EDT files, you can upload the primary care reports into OSCAR via Admin > Upload MOH Files to have the same View MOH File functionality.

Processing OHIP Roster & Capitation Payment Reconciliation Reports

The OHIP Roster & Capitation Payment Reconciliation (Roster) files are labelled:

*   RCX-<OHIP#>-<Group#>-S-<Date>.xml for payments to solo practitioner

*   RCX-<Group#>-<OHIP#>-H-<Date>.xml for payments to group

When you click on these files from the Admin > View MOH Files page, the file is processed to update patient master demographic records with roster information provided by MOHLTC.

Demographic Record Updates

When the OHIP Roster & Capitation Payment Reconciliation (Roster) report is processed, the following fields are updated in the master demographic record:

Demographic Record Field

Description

MOH Roster Status

This field is set to RO (rostered) or TE (terminated), based on the Roster report. This field is not editable by users. It is only updated when the Roster report is processed.

Roster Date

This field is set to the Roster Start Date in the Roster report. Any previous date in this field is overwritten after processing the Roster report.

Enrolled Physician

This field is set to the physician of the Roster report. Any previous data in this field is overwritten after processing the Roster report.

Enrolled Physician CPSO

This field is set to the Enrolled Physician's CPSO number. The CPSO number is taken from the Admin > Provider profile.

Roster Termination Date

This field is set to the Roster End Date in the Roster report. Any previous date in this field is overwritten after processing the Roster report.

Roster Termination Reason

This field is set to the Term Code in the Roster report. Any previous code in this field is overwritten after processing the Roster reports.

MOH Roster Date

This field is invisible to users. It indicates when the last Roster report was processed.

Last Updated User

This field is invisible to users. It indicates the person who last edited the demographic record - in this case, it is the person who processed the Roster report.

Last Updated Date

This field is invisible to users. It indicates when the demographic record was last edited.

Patients in the Roster & Capitation Payment Reconciliation (Roster) XML report are processed and displayed according to the category below:

Newly Rostered Demographics

These are patient demographics who had their MOH Roster Status updated to RO (previously it was not set).

When you click on the health card number (HIN) of these patients, their Master Demographic Record opens.

Roster Terminated Demographics

These are patient demographics who had their MOH Roster Status updated to TE, their Roster Termination Date set, and their Roster Termination Reason set.

When you click on the health card number (HIN) link of these patients, their Master Demographic Record opens.

Rostered Demographics Missing from OSCAR

These are patients in the Roster report, whose health card number is not found in the OSCAR database.

When you click on the health card number (HIN) link of these patients, an Add a Demographic Record window opens for you to add this specific patient to your demographic database in OSCAR.

Existing Rostered Demographics

These are patient from the Roster report, whose demographic MOH Roster Status is already set to RO.

When you click on the health card number (HIN) link of these patients, their Master Demographic Record opens.

Re-processing OHIP Roster & Capitation Payment Reconciliation Reports

Note that you can re-click the OHIP Roster & Capitation Payment Reconciliation XML file from View MOH Files page to re-process the roster information. This will process and display patients in the rostered category sections (as listed above) again, however, demographic records are not updated if the date on the Roster XML file is before or equal to the last time that demographic has been updated by processing the Roster XML file (i.e., the XML file date <= MOH Roster Date).

This feature allows you to add rostered patients that are missing from your OSCAR demographic records, and then re-run the report again to update their roster information, while not affecting other demographics with un-changed roster status. In addition, if you tried to process an older Roster report, the demographic information is not updated to the older data.