Ontario Health Insurance Plan (OHIP)

 HEALTH CARD VALIDATION GUIDELINES 

Each eligible resident in the province of Ontario may apply to be an insured person to receive provincially funded insured health services covered by the Ontario Health Insurance Plan (OHIP). A health card is provided to the insured person to present to the health care provider at each visit for an insured health service. 

Health card validation (hcv) allows a health care provider to access the Ministry of Health’s Registered Persons Database to determine the status of a health card number (hcn) and version code when presented at point of service. The health card is to be validated each time the patient registers. Along with the health card check and response code, registration staff is also expected to review the health card including the individual’s photo, and date of birth. If a discrepancy is apparent, additional information and identification should be requested 

Hcn verification is done during booking, pre-registration and/or the registration process. 

PROCEDURE FOR VALIDATING HEALTH CARD NUMBER 

1. Perform the MPI search as usual: by entering the health card number, Medical Record number, Date of Birth DDMMYY or patient LAST NAME, FIRST NAME. 
2. On Demographic tab, Health Care Num field check the hcn and verify corresponding number and version code.  Hyphen separates the hcn and 2 character upper case alpha version code. 

3. Click on validate HC Number footer button: 

NOTE: If the Validate HC Number is low lit (gray), delete Ontario from the Prov Issuing HC number field and re-enter Ontario. The Validate HC Number field will become available to select. 

4. The system will perform validation process.   
5. A MOH Validation box will appear showing the patient name, date of birth birth sex, expiration date, eligibility status, hcn, return code and return code description. i.e., 

6. Click “OK”. 
7. If the card status is Denied, the Validation fields will become required. (*)  MOH ticket number field is for ER visits only. 

8. On the Insurance tab, the Eligibility Status field on the Policy Holder section will default with either Verified or Denied depending on the response code. 
9. Verify that the subscriber name is correct -same as patient name. The user can then proceed with the registration. Follow site specific guidelines and processes for patients with no OHIP card or validation responses of Denied or queued.

Follow site specific guidelines and processes for patients with no OHIP card or validation responses of Denied or queued.

Health Card Validation Response Codes 

 OHIP Fraud 

OHIP fraud includes: 

• Someone knowingly using a health card that is not theirs 
• Non-resident of Ontario knowingly receiving OHIP services when they are not eligible 
• Someone who has stolen another person’s identity in order to receive OHIP benefits 

Ministry Fraud line must be contacted for any case of suspected fraud.

Process for suspected fraudulent use of health card. 

1. contact the Ministry Fraud Line at 1-800-265-4230 or e-mail reportohipfraud@moh.gov.on.ca 

The following information will be requested by the Ministry: 

• Caller name, title, hospital address and contact phone number 
• OHIP number used, name attached to hcn 
• Name, address of person who used hcn (? Not in e-mail?) 
• Service date hcn used 
• How suspected use of card was identified 

The Ministry will follow up as needed.  As per Ministry, all information will be handled according to privacy regulations.   

Follow Site specific procedure for required corrections and any additional notifications.