RAMQ for Ontario Physicians

Why This Guide Exists

Quebec patients show up everywhere in Ontario. The Ottawa region is the obvious example, but they also turn up in Toronto walk-in clinics, Mississauga emergency departments, and rural Northern Ontario hospitals. If you are an Ontario physician who sees patients, you will eventually see a RAMQ card.

Unlike most other provinces, Quebec is not part of the standard reciprocal billing arrangement for physician services. You cannot bill RAMQ patients through OHIP the way you can a B.C. or Manitoba patient. You have to choose one of three paths, and the choice has real implications for how, when, and how much you get paid.

This guide walks through all three options, helps you pick the right one for your practice, and gives you the registration and submission steps for each.

The Three Options at a Glance

Decision Tree

1. 1.Do you regularly see Quebec patients in your practice? If yes, go to Option B (register with RAMQ). If no, continue.
2. 2.Do you need to be paid before the patient leaves? If yes, go to Option A (bill patient directly). If no, continue.
3. 3.Do you see Quebec patients rarely, and you are comfortable filling out one form per encounter and waiting 4 to 12 weeks for RAMQ to pay you? If yes, go to Option C (Form 4292). If no, default to Option A.

Option A: Bill the Patient Directly

Simplest path. You treat the patient, you collect payment at point of care, you give the patient a receipt with the right information on it, and the patient submits to RAMQ for reimbursement. RAMQ pays the patient, not you.

When This Works Well

• Private clinics where direct payment is the norm (cosmetic, sports medicine, executive health).
• Locums or rural physicians who see a Quebec patient once or twice a year.
• Services where your fee is materially higher than what RAMQ would pay (you get full fee from patient; they recover only RAMQ rate).

When This Backfires

• Emergency department visits. Most Quebec patients are not carrying enough cash or credit for an ED bill, and ED culture in Ontario does not support point-of-care payment.
• Hospital in-patient services. There is no clean way to collect from an admitted patient.
• Patients who are clearly going to dispute the charge or never submit to RAMQ.

How to Do It Properly

1. 1.Confirm the patient is RAMQ-insured (Quebec health card; not OHIP, not federal, not private insurance).
2. 2.Explain in plain language, before the encounter: “Your Quebec card does not cover my services here. I charge $X. You pay me today and submit to RAMQ for reimbursement; they pay you back at their rate, which may not be the full amount.”
3. 3.Collect payment. Most physicians use Square, Helcim, or a simple Stripe terminal. Cash is fine.
4. 4.Issue a receipt with the required elements (see below).
5. 5.Document the encounter as usual.

Required Receipt Elements

RAMQ will reject a patient submission with an incomplete receipt. Include all of the following.

• Your full name, professional designation, and Ontario CPSO number.
• Your billing address.
• Patient full name, date of birth, and RAMQ number.
• Date of service.
• Diagnosis (ICD-9 or descriptive).
• Service performed with a clear description (RAMQ act code is helpful but not mandatory for cross-border).
• Provincial service code for the care provided (if applicable).
• Amount charged, in Canadian dollars.
• Confirmation that payment was received in full.
• Your signature and the date.

Option B: Register as a RAMQ Provider

If you see Quebec patients regularly, registering with RAMQ lets you bill them directly. RAMQ pays you, the way OHIP pays you for Ontario patients, but under RAMQ rules and the RAMQ act codes.

When Registration Makes Sense

• ED groups in border regions (Cornwall, Hawkesbury, Pembroke, Ottawa, Renfrew).
• Family practices within reasonable distance of the Quebec border.
• Frequent locums on the Ontario side of the Outaouais.
• Any practice where Quebec patients make up a meaningful share of monthly billings.

Registration Steps

1. 1.Go to the RAMQ professional services portal at ramq.gouv.qc.ca and locate Form 3003, titled “Demande d’inscription comme professionnel de la santé hors Québec” (Application for Out-of-Quebec Provider Registration).
2. 2.Complete Form 3003 in either French or English. Required fields include your full legal name, Ontario CPSO number, and professional address. To receive payment by direct deposit, also complete and attach Form 4552 (banking authorization).
3. 3.Complete Form 2049 (“Attestation of Right to Practice: Health Professional Outside Quebec”) and email the completed form to membership@cpso.on.ca with a request for their seal. Wait for the CPSO to email back the completed and sealed form. This typically takes a few days.
4. 4.Complete Form 3065 (“Application for Participation: Health Professional Outside Quebec”).
5. 5.Attach a copy of your CPSO certificate of registration and your medical degree.
6. 6.Submit the four forms either by mail to the RAMQ address below or by email to servicesprofessionnels@ramq.gouv.qc.ca:

1. 1.Wait 4 to 8 weeks for processing. RAMQ will issue you a Quebec provider number (“numéro de pratique”) by mail.
2. 2.Set up access to the RAMQ professional portal using your provider number.

How Billing Differs from OHIP

Option C: Bill RAMQ Directly Using Form 4292

The middle path for physicians who see Quebec patients rarely. You do not register with RAMQ, but you also do not ask the patient to come up with the money on the spot. Instead, you complete RAMQ Form 4292, mail it to RAMQ, and RAMQ adjudicates the claim and pays you directly. The patient does nothing after the visit.

Form 4292 is the English version of Form 2688 (“Réclamation hors province pour services médicaux” / Out-of-Province Claim for Physician Services). It exists precisely for the situation MedConcierge users find themselves in: an Ontario physician treating a Quebec resident once or twice a year, with no existing RAMQ provider registration.

An important practical detail: on Form 4292 you can use either the OHIP fee code (the one you would have used if the patient had been Ontario-insured) or the corresponding RAMQ act code. RAMQ adjudicates the claim at their rate either way. Most Ontario physicians use OHIP codes because that is what they have at hand; either is acceptable.

When Option C Works Well

• Emergency department or in-patient services where you cannot reasonably collect from the patient at point of care, and Quebec patients are a rare occurrence in your practice.
• One-off encounters at a clinic where you do not see Quebec patients regularly enough to justify the registration overhead of Option B.
• Services with a clean RAMQ act-code equivalent (or where you are comfortable letting RAMQ map an OHIP code to one).

When Option C Does Not Fit

• Regular Quebec patient practice. Register as a RAMQ provider (Option B) instead so you can bill in batches with proper electronic infrastructure.
• Services RAMQ does not cover for out-of-province residents (certain elective procedures, services deemed experimental, cosmetic services). RAMQ may reduce or reject the claim. Bill the patient directly (Option A) for those services.
• Services where your usual fee materially exceeds RAMQ’s rate for the equivalent act code. You will only receive RAMQ’s rate, regardless of whether you submitted an OHIP code or a RAMQ act code.

Where to Find Form 4292

Form 4292 is available as a PDF on the RAMQ website. The direct URL is ramq.gouv.qc.ca/sitecollectiondocuments/professionnels/formulaires/4292.pdf. Print copies in your clinic; the form does not change often.

If the URL above ever moves, search the RAMQ professional site for “Form 4292” or “Out-of-Province Claim for Physician Services.” The French equivalent is Form 2688.

How to Complete Form 4292

The form is single-page and structured for the provider. You complete all of it. The patient does not need to sign.

Provider sections

• Provider full name, professional designation, and mailing address.
• Provider Ontario CPSO number.
• Provider Canadian Medical Protective Association (CMPA) policy number if requested.
• Provider signature and date.

Patient sections

• Patient full name and date of birth.
• Patient RAMQ health card number, exactly as it appears on the card.
• Patient address (Quebec address from the health card, not an Ontario forwarding address).

Service sections

• Date(s) of service.
• Diagnosis (ICD-9 code or descriptive).
• Service rendered, with a service code. You can use either the OHIP fee schedule code (recommended; this is the code you are already familiar with) or the corresponding RAMQ act code. RAMQ will adjudicate either way and pay at their rate.
• A clear written description of the service. RAMQ uses the description to validate the code, particularly when an OHIP code is supplied and the RAMQ reviewer needs to map it to a Quebec equivalent.
• Amount claimed in Canadian dollars.
• Note any private travel insurance the patient mentioned. RAMQ has coordination agreements with several Canadian insurers and may forward the claim accordingly.

Where to Mail Form 4292

Form 4292 is paper-mail only. As of this writing, RAMQ does not accept Form 4292 by email, fax, or upload portal. Mail the completed and signed form, with a copy of any supporting documentation (operative report for major surgery, consult letter, etc.), to:

Submission Deadline

You have 1 year from the date of service to submit Form 4292 for physician services. For hospital services, the window is 3 years. RAMQ may accept a late submission if you can demonstrate inability to act earlier, but do not rely on this. Mail the form within the year.

Payment Timeline

Typically 4 to 12 weeks. RAMQ may take longer if they need clarification on the act code or supporting documentation. If you have not heard anything after 12 weeks, follow up using the contact information on the form.

Common Pitfalls

Trying to bill OHIP for a Quebec patient

It will reject. OHIP error code V20 (patient not eligible) or V22 (out-of-province) is the most common signal. Do not resubmit; switch tracks to Option A, B, or C.

Accepting the RAMQ card without checking the expiry date

Quebec health insurance cards are valid for up to 8 years and have a printed expiry date. An expired card means the patient is not currently covered for billing purposes; they may need to pay directly and renew before reimbursement is possible. Always check the expiry date when the card is presented.

Misreading the Quebec health card number format

Quebec health card numbers are 12 characters: the first 4 are letters (derived from surname, given name, and date of birth), followed by 8 digits. This is different from the Ontario format (10 digits plus a 2-letter version code). Capture the full 12 characters exactly as printed on the card; partial captures will cause rejections.

Mailing Form 4292 to the wrong RAMQ department

The postal box (C.P. 6600, succ. Terminus, G1K 7T3) is shared across multiple RAMQ services. If you do not specify “Service de l’application des programmes” on the envelope, your claim may sit in another team’s queue for weeks before being rerouted. The line is small but important.

Charging the patient before confirming what you'll do

Be transparent. Tell the patient up front: “You’re from Quebec. I’ll bill RAMQ directly for this visit; you don’t pay anything today.” That is the cleanest message when you are using Option C. If you are using Option A and the patient will pay, say so clearly and explain why. Surprises late in the visit do not go well.

Not documenting consent for Option A

If the patient is paying out-of-pocket for a service that would have been free under OHIP, document the conversation. “Patient is RAMQ-insured. Explained that this service is not reciprocally billed; patient understands payment terms and submission process.” Belt and braces.

Not keeping copies

Form 4292 submissions are paper-based. If your copy is gone, you have nothing to point to when RAMQ comes back six weeks later asking a question. Scan or photocopy every form before you mail it.