Visual Practice HOW TO

...Visual Practice's Intellicard Health Card Validation Strategy Overview

The Ontario Ministry of Health's Health Card Validation Service

The Ontario Ministry of Health Health Card Validation Services consists of two services, HCV (Health Card Validation Service) and OBEC (Overnight Batch Eligibility Checking) which have been developed to enable providers to validate the health card number and version code status.  The main difference between these two services is one is an immediate service (HCV) and one is a delayed service (overnight).  While the immediate service has an ongoing cost associated with it (HCV), the delayed service (OBEC) is free and is delivered through your EDT account.

Visual Practice also enables you to send patients to a 'list' in order to validate everyone in one HCV or OBEC session, reducing the number of phone calls you need to make to the service.  

On the downside of HCV (the immediate service), connection to the HCV service requires a datapac account with Bell Canada, and an HCV account with the Ministry of Health.  Bell Datapac is a monthly subscriber service that starts at $25 per month and has a traffic fee associated with it.  The traffic fee is calculated based on your distance from the Kingston HCV local service, and can be as little as 20 cents a card swipe and as much as 50 cents a card swipe.  Unless you are a walk-in clinic with significant EH2 issues, its is generally better to go with OBEC than with HCV.

The Ministry service itself that validates cards requires an account setting in your EDT service.  OBEC and HCV signup forms are available to Ontario health care providers, and the Ministry of Health can provide you with an application form for subscribing to the service.  Contact the OBEC and HCV helpdesk for this form at 1-800-262-6524.

What does validation actually do?

When you use Visual Practice to validate health cards and version codes, Visual Practice uses your modem, and your EDT account and logs into the Ministry of Health's mainframe application that responds to requests for validation of health card numbers and version codes.  OBEC sends a list for processing overnight, whereas HCV sends a list for immediate validation.  Neither service provides you with correct health card numbers and version codes, it only reports if the Ministry of Health will honor payment for a service if the health card number and version code are submitted with a billing under OHIP.

The validation process consists of edit checks to ensure:

• a valid Health Card (in the case of a "swiped" transaction)
• a valid ten-digit Health Number that has been issued by the ministry

If this is not the case, the response indicates the reason why this card/number has been rejected and no further processing takes place.

• A check to ensure that the Health Number presented belongs to a registrant who is eligible for health care in the province of Ontario. If the registrant is not eligible, a response code will be returned indicating this.
• Validation of the version code. 

Benefits of Validation

Validation responses provide decision-making capability at the time of service and allow a health care provider to:

• reduce eligibility rejects
• reduce version code rejects
• reduce fee-for-service rejects
• reduce administrative costs
• reduce health care fraud
• confirm uninsured clients for direct billing
• verify patient data

What is "Intellicard"?

Visual Practice intelligently uses sources of card validation to maintain an up to date (as much as possible) reference for a patient's health card status.  If you have a look at the Patient Registry > Card tab field, you should see fields related to health card validation:

The Validation options are None, HCV Later and OBEC.  These fields are used to flag patients for specific forms of validation.  When you elect to do an HCV or OBEC submission, Visual Practice batches lists of patients and data to go out for validation to these services.

Once a response comes back, the result is stored in the Result section.  A card can be Valid, Invalid, or Not Validated.  If a patient has been checked, the card information will read as Valid or Invalid.  Further information is available below the Result section.  The Date Validated field tells you when the validation happened (giving you an idea of how old the results are, and the Method shows you which method was used to perform the validation, and also contains the actual result code coming back from the Ministry validation system.

So as you can see, all of the validation data and control is centered on the patient's card tab field.  You can also trigger these fields on individual patients through the Card tab Validation options.

Using "Intellicard"

Intellicard is a group of features within Visual Practice which ensure validation occurs and validation information is kept up to date.  Intellicard also uses your submission Error Claim Reports and your Reconciliation Advice reports to fill the Result section.  When MOHLTC Claims Service rejects a patient based on an eligibility error, this error is recorded as a validation error in the patient file.  Similarly, if a claim is paid, it is a defacto admission by MOHLTC that the health card and version code are correct!  This is a hidden and very useful piece of information that Intellicard uses to keep your validation information up to date. 

If a patient's eligibility fails on a submission Error Claim Report or Reconciliation Advice file, the patient's Result section will reflect this as "Invalid".  You can always tell why this occurs by looking at the Date Validated and Method fields below.

Where "Intellicard" comes in handy.

Regardless of what method of validation you use, if you use the Health Card Swipe Wizard option in Visual Practice, each patient's validation information is double checked.  By swiping a patient's card you are checking to see if there are any recorded validation issues with that patient. 

IF the patient's Result field is Invalid, the Swipe process will warn you.  The main benefit of this is catching the error while the patient is standing in front of you.  It is always easier to deal with health card errors when the patient is standing in front of you, rather than after the service is delivered and you're forced to chase them.