Canadian Solutions
Agentic AI for Ontario physician billing
A step-wise platform for eliminating OHIP revenue leakage before claim submission — from retrospective analysis to full agentic deployment inside Canadian physician workflows.
Periodic Health Visit
A. Tremblay · rostered · ON
Q050
Preventive care bonus
Q040
Diabetes management flow sheet
A007 + Q012
Chronic disease premium
K013
Counselling — 2nd unit
E079
After-hours premium
Recovered this visit
Missed premiums + Q-codes, before submission
$0.00
$1.6B
uncaptured physician revenue annually in Canada
5%+
of insured services never billed
0
agentic AI billing platforms purpose-built for Ontario
Integrations
Plugs into the systems you already run.
OSCAR, Accuro, and Avaros are coming soon — the EMRs that run most Ontario family practices — with TELUS integration in progress. Aletheia sits on top of your existing EMR — no rip-and-replace.
Embedded in your EMR
OSCAR ProComing soon
Accuro EMRComing soon
Avaros EMRComing soon
TELUS PS SuiteIn progressTELUS Med AccessIn progressThe Ontario Problem
Revenue leakage is structural, not accidental
Physicians do the clinical work, but Ontario billing opportunities can disappear because the EMR rarely surfaces the right OHIP code, premium, roster, or bonus window at the moment of care.
Roster-wide eligibility is invisible
Tracking Q-code eligibility across 1,200+ patients means missed K030 visits, Q040 windows, Q050 flowsheets, and bonus deadlines often surface only after the revenue is gone.
Rules are strict and combinatorial
Q012 must appear with the visit code, Q015 only works with A007, and Q040 requires three K030 visits in 12 months. Wrong combinations can silently reject or underpay claims.
Acuity undercoding compounds monthly
Under FHO+, incomplete diagnostic coding can assign patients to lower acuity bands, reducing capitation quietly across every affected rostered patient.
Clinic Deployment Model
Prove the leakage retrospectively, then deploy agentic billing operations
Retrospective Clinic Analysis
We ingest your historical OHIP billing exports, identify missed codes and premiums, and quantify revenue leakage before asking your team to change workflow.
- 12-month OHIP/MCEDT analysis
- Missed Q-code and premium detection
- Itemized revenue recovery report
Pre-Submission Validation Layer
Once value is proven, we deploy the validation layer into billing operations so leakage is caught before claims leave the practice.
- OHIP rule validation
- Q-code eligibility alerts
- Denial-risk review queue
Full Agentic Orchestration Platform
We then expand into the full agentic platform across documentation, billing, roster intelligence, MCEDT submission, and remittance reconciliation.
- NLP documentation agent
- Roster and acuity intelligence
- Submission and remittance reconciliation
Agentic Architecture
Autonomous agents across the billing lifecycle
The supervisory orchestrator coordinates documentation, Q-code tracking, roster intelligence, MCEDT submission, and remittance reconciliation while preserving physician review for edge cases.
NLP Clinical Note Agent
Reads SOAP notes and maps documented care to OHIP billing codes.
Billing Rule & Q-Code Agent
Tracks Q040, Q050, Q012, Q020/Q021, timing windows, and rule combinations.
Roster Intelligence Agent
Reconciles EMR and Ministry rosters, flags panel loss, and triggers re-rostering workflows.
Submission & Reconciliation Agent
Builds clean MCEDT batches, tracks rejections, and reconciles remittance against expected payment.
Platform Requirements
Built for Canadian infrastructure, compliance, and physician workflow
Ontario Data Layer
OHIP billing files, MCEDT parser, OSCAR plugin, Accuro connector, and future HL7/FHIR adapters.
Agentic AI Engine
OHIP ruleset, denial-risk models, eligibility state tracking, acuity band prediction, and LLM note extraction.
Physician Workflow
Daily clean-billing summary, one-click approve/dismiss queue, monthly recovery reports, and EMR-embedded widgets.
Canadian Compliance
PHIPA/PIPEDA handling, Canadian data residency, encryption, audit trails, and OntarioMD VOR pathway.