Visual Practice HOW TO

...MRO Electronic Data Transfer (EDT) Reconciliation

The Ontario Ministry of Health informs providers of their accounting response to MRI submissions with an MRO file called a Reconciliation Advice file (RA).  When a provider uses the EDT method of submission and reconciliation, a number of response files can be "fetched" from the Ministry of Health EDT system.  The process of fetching response files can be started by selecting Ministry of Health in the File menu, then selecting Communications (GONet) and finally, Fetch Reconciliations. As shown below:

 

When the Fetch process starts, you will be asked which provider to perform the fetch for.  The provider selection form is almost exactly the same as the disk reconciliation provider.  Select the provider(s) you would like to perform a Fetch for, click on the Add>> button,  as shown below:

The communications process will begin and you will see a communications screen similar to the screen seen in an EDT Submission:

 

During the communications process, any files that the Ministry of Health places in your Inbox will be downloaded onto your PC.  Once the communications process has completed, Visual Practice will read these files and process them.  Each file has a different purpose.  The files that Visual Practice is designed to read, report on and integrate are:

File Reject Messages are usually available for electronic pickup (via the Fetch Reconciliation option in Visual Practice) within a few hours of claims file submission.  This is an automated process and is independent of the monthly claims cycle; therefore, a File Reject Message may be sent any day of the week or month.  The File Reject Message is read by Visual Practice and is automatically printed when fetching reconciliation files from the EDT system.

Claims Batch Edit Reports are usually available for electronic pickup with 24 to 48 hours of the claims file submission.  This holds true on days that the Ontario Ministry of Health processes claims.  This report is produced from one of the first processes in the claims system.  If claims are uploaded on a weekend, holiday or at month-end, the batch edit is available for electronic pickup on the next claims processing day. The Claims Batch Edit Reports are read by Visual Practice and are automatically printed when fetching reconciliation files from the EDT system.

Claims Error Reports are usually available within 48 hours of claims file submission.  As noted above, this is the case on the days that the Ministry of Health processes claims.  This report is produced near the end of the claims processing stream.  As is the case above, if claims are uploaded on a weekend, holiday or at month-end, the error report is delivered at the end of the next claims processing day.  The Claims Error Reports are read by Visual Practice and are automatically printed when fetching reconciliation files from the EDT system.  Additionally, Visual Practice marks all rejected claims within this report as 'R' for rejected in the status column of the OHIP Bill and reports the error code in the ERR column.  This makes error correction much easier.

Remittance Advices (MRO - RA) are produced during the three to four day period at the end of the month and are delivered when month-end processing is completed.  This usually falls between the 5th and the 7th day of the month.  The Remittance Advices are read by Visual Practice and are automatically printed when fetching reconciliation files from the EDT system.  Additionally, Visual Practice marks all rejected claims within this report as 'R' for rejected in the status column of the OHIP Bill and reports the error code in the ERR column.  This makes error correction much easier.  Also, claims that have been Accepted or Adjusted are marked accordingly.  The Remittance Advice files contain accounting data that reports monies paid. This information is integrated into Visual Practice automatically, making accounting reconciliation a simple and fast process.

EDT Processing Schedule

The cut-off date for EDT claims submission is the 18th of the month.  EDT claims may be submitted anytime, 24 hours a day, 7 days a week. The Ontario Ministry of Health recommends submitting claims frequently (daily or weekly) throughout the month to facilitate smooth processing and timely correction of errors. This may enable providers to correct rejected claims and resubmit them during the current processing cycle.  EDT claims received after the 18th are processed until the month-end computer cut-off date, where time and volumes permit.

The Ontario Ministry of Health processes claims overnight on most business days, with the exception of statutory holidays and during a three to four day period at the end of the month when month-end processing and generation of payment data occurs.  This period could be extended to a four to five day period if major system changes are being implemented.