ClaimMD runs overnight, scans your OSCAR encounters, and surfaces every missed OHIP billing code and P4P bonus opportunity before 7 AM. Zero physician time required.
ClaimMD is a rules-based billing intelligence engine — not a vague AI tool. It knows the OHIP fee schedule, your P4P thresholds, and your enrollment model.
ClaimMD cross-references every encounter in OSCAR against the OHIP fee schedule for your enrollment model. It reads clinical notes to find add-on codes your EMR never prompted — like mental health, complex care, and preventive codes.
ClaimMD parses your Ministry of Health TPSR reports and tracks your progress toward every P4P indicator. You'll know exactly which patients need a qualifying visit before the March 31 fiscal close — weeks in advance, not days.
ClaimMD connects to OSCAR via a read-only API. We never write to your EMR, never share patient data, and operate fully within Ontario's PHIPA requirements. Your patients' data stays in Ontario, encrypted at rest and in transit.
The entire engine runs overnight while you sleep. You wake up to a prioritized digest ranked by dollar value. Approve items in 5 minutes over coffee — or forward approved codes directly to your MOA for submission.
Adjust the sliders to your practice profile and see a conservative estimate of annual recoverable revenue.
"I had no idea I was missing mental health add-on codes on nearly every qualifying visit. ClaimMD found it in the first scan."
"The P4P tracker is the real game-changer. I used to miss the March 31 close every year. Not anymore."
"Five minutes in the morning. That's genuinely all it takes. My MOA handles the submissions and we recovered $22K in year one."
P4P bonuses you haven't claimed yet disappear on that date. Book a 20-minute demo and we'll show you exactly what you're leaving on the table — before it's too late.
ClaimMD was designed for physicians who don't have 30 minutes a day to spend on billing admin. Here's exactly what happens.
Grant ClaimMD read-only access to your OSCAR Pro account via the WELL Star Health developer API. We also confirm your enrollment model (FHO, FHN, FHG, or CCM) so the rules engine knows exactly which codes and thresholds apply to you.
At 11 PM, ClaimMD scans every encounter from the past 30 days. It cross-references the OHIP fee schedule, reads clinical notes for qualifying language, parses your TPSR report, and calculates the dollar value of every missed opportunity — ranked by size.
Before 7 AM, you receive a prioritized morning digest. Open the dashboard, review each item, and approve or dismiss with one click. Approved items are queued for submission — your MOA handles the rest, or ClaimMD can queue them directly.
ClaimMD is a precision rules engine. Every recommendation is grounded in the current OHIP fee schedule and Ministry of Health guidelines — not a black box.
Still have questions? Book a 20-minute demo and we'll walk through your specific practice setup.
Book a 20-minute walkthrough. We'll connect to a demo OSCAR environment and show you exactly what ClaimMD would have found in a typical week.
This is a live demo environment. The real dashboard connects to your actual OSCAR data and runs every night.
ClaimMD is priced so that recovering even one missed billing opportunity per week covers the cost entirely.
One recovered annual exam code pays for a full month of ClaimMD. Most physicians recover 40–80× the subscription cost in year one.
ClaimMD was built by a team that watched family doctors leave thousands of dollars on the table every year — not through negligence, but because billing complexity has outpaced the tools available.
Ontario's capitation model was designed to reward comprehensive, longitudinal care — but the billing rules that govern it are extraordinarily complex. Between the OHIP fee schedule, enrollment-model-specific codes, and P4P indicator thresholds, a family physician in an FHO faces hundreds of potential billing interactions every week.
Most billing tools address this at the point of care. They prompt you during the visit, adding cognitive load to an already demanding encounter. ClaimMD takes a different approach — we work retrospectively, overnight, so that nothing about your clinical day changes.
The result is a platform that operates like a silent billing partner: it knows the fee schedule cold, it reads your encounter notes for qualifying clinical context, and it surfaces every recoverable opportunity before you've seen your first patient of the day.
We are Ontario-specific by design. We don't serve physicians in BC or Alberta. We serve Ontario family physicians enrolled in capitation models, using OSCAR Pro. That focus means our rules engine is deeper, our P4P tracking is more accurate, and our recommendations are more actionable than any general-purpose billing tool.
Security and privacy are non-negotiable. Here's exactly how ClaimMD handles your data.
Book a 20-minute call. No sales pressure — just a walkthrough of what ClaimMD would find in your specific enrollment model.
ClaimMD was built from the ground up for Ontario's healthcare privacy requirements. Every architectural decision, from how we connect to OSCAR to how data is stored to who can see what, was made with PHIPA compliance as the foundation, not something added later.
These are not settings we can adjust or policies we can override for individual accounts. They are built into the architecture of how ClaimMD works.
ClaimMD runs one automated overnight job. Here is exactly what data moves, where it goes, and how it is protected at each step.
ClaimMD uses Row Level Security, a database-level enforcement system, to ensure every user sees exactly what they are authorized to see and nothing more. This cannot be bypassed by application code.
| Data type | Physician | MOA (Approve) | MOA (View) | ClaimMD Staff |
|---|---|---|---|---|
| Patient full name | ✓ | Configurable | ✗ | ✗ |
| OHIP health card number | ✓ | ✗ | ✗ | ✗ |
| Billing opportunities (anonymized) | ✓ | ✓ | ✓ | ✗ |
| Approve or dismiss actions | ✓ | ✓ | ✗ | ✗ |
| P4P gap patient list | ✓ | ✓ (anonymized) | ✓ (anonymized) | ✗ |
| Revenue analytics | ✓ | Configurable | ✗ | Totals only |
| Full audit log | ✓ | Own actions | Own actions | ✗ |
| OSCAR raw encounter data | ✓ | ✗ | ✗ | ✗ |
| Manage user access | ✓ | ✗ | ✗ | ✗ |
Row Level Security controls who can access data inside the system. Encryption protects data from anyone who bypasses the system entirely. ClaimMD uses both, independently.
The compliance relationship between a physician and ClaimMD requires one document from the physician. Here is a complete picture of every agreement involved.
These are the real questions physicians raise before getting started. We answer them directly, without hedging.
Every ClaimMD physician receives a copy of the Data Processing Agreement, a summary of our security architecture, and answers to their compliance questions before their first billing scan runs.