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Canadian Medicare Billing for Hospitals 2026 — OHIP, MSP, RAMQ & Provincial Billing Guide
Complete guide to Canadian hospital Medicare billing — OHIP (Ontario), MSP (BC), AHCIP (Alberta), RAMQ (Quebec), provincial fee schedules, telehealth billing, and billing software.
Canadian Medicare is provincially administered — OHIP, MSP, AHCIP, RAMQ. Each province has its own fee schedule and billing system. This guide covers Canadian hospital billing.
Provincial Billing Systems
| Province | Plan | Billing System | Fee Schedule |
|---|---|---|---|
| Ontario | OHIP | Teleplan/EDI | OHIP Schedule of Benefits |
| BC | MSP | Teleplan | MSP Payment Schedule |
| Alberta | AHCIP | EDI/Claims | Schedule of Medical Benefits |
| Quebec | RAMQ | RAMQ portal | Manual of Physicians' Services |
| Manitoba | Manitoba Health | EDI | Manitoba Fee Schedule |
| Saskatchewan | Sask Health | EDI | Saskatchewan Fee Schedule |
| Nova Scotia | MSI | EDI | MSI Fee Schedule |
| New Brunswick | Medicare | EDI | NB Fee Schedule |
Billing Process
- Patient registration: Register patient with provincial health card
- Eligibility verification: Verify provincial health coverage
- Service delivery: Provide medical service with documentation
- Fee code selection: Select appropriate fee code(s) from provincial schedule
- Claim submission: Submit claim to provincial billing system (EDI/portal)
- Payment: Provincial plan processes and pays claim
- Reconciliation: Reconcile payments with claims
- Denial management: Appeal denied claims
Telehealth Billing by Province
| Province | Telehealth Codes | Video/Phone | Notes |
|---|---|---|---|
| Ontario | K080, K081, etc. | Video + phone | Permanent codes post-COVID |
| BC | Teleplan codes | Video + phone | Permanent codes post-COVID |
| Alberta | AHCIP codes | Video + phone | Permanent codes post-COVID |
| Quebec | RAMQ codes | Video + phone | Permanent codes post-COVID |
| Manitoba | Manitoba Health | Video + phone | Permanent codes post-COVID |
Frequently Asked Questions
- How does Canadian Medicare billing work?
- Canadian Medicare is provincially administered. Each province has its own billing system: 1) Ontario — OHIP (Ontario Health Insurance Plan), 2. BC — MSP (Medical Services Plan), 3. Alberta — AHCIP (Alberta Health Care Insurance Plan), 4. Quebec — RAMQ (Regie de l'assurance maladie du Quebec), 5. Other provinces have their own plans. Doctors bill the provincial plan using fee codes. Hospitals are globally funded (not fee-for-service).
- What are the key provincial fee schedules?
- Canadian provincial fee schedules: 1) OHIP Schedule of Benefits (Ontario), 2. MSP Payment Schedule (BC), 3. AHCIP Schedule of Medical Benefits (Alberta), 4. RAMQ Manual of Physicians' Services (Quebec). Each schedule has thousands of fee codes for services. Fee amounts vary by province. Physicians must register with the provincial plan to bill.
- Can Canadian hospitals bill for telehealth?
- Yes, Canadian provinces have telehealth billing codes: 1) Ontario — OHIP telehealth codes (K080, K081, etc.), 2. BC — MSP telehealth codes (teleplan), 3. Alberta — AHCIP telehealth codes, 4. Quebec — RAMQ telehealth codes. Telehealth billing expanded significantly during COVID-19 and many codes are now permanent. Requirements vary by province (video vs phone, patient location).