File hospital dental claims without retyping patient and provider details

Dentists and dental surgeons submitting OHIP claims for insured in-hospital dental services repeat patient identifiers and billing information on every claim form. This guide is an example of storing them once in hivi.

Official form and source

Start from the official source and always use the current version — form numbers and links can change:

• Service page: Claims submission — Resources for Physicians — ontario.ca
• Form (Central Forms Repository): Dental Claim — 014-3653-41

What this form is about

Form 014-3653-41 is the Dental Claim form, used by dental professionals to bill OHIP for insured dental surgical services performed in hospital settings under the Schedule of Dental Benefits.

Before you start: what to gather

• Patient full name, health number, and date of birth.
• Hospital name and admission or service dates.
• Your OHIP billing number and practice details.
• Procedure codes and supporting clinical information as required.

Confirm the current process on ontario.ca.

How hivi makes it faster

1. Save it once. Store your patient identifiers and provider billing details in your hivi profile.
2. Keep documents ready. Upload supporting documents to hivi Files so you are not searching at form time.
3. Autofill the form. Use the hivi Chrome extension on a web form, or fill a PDF from your saved profile inside hivi.
4. Review and submit yourself through the official channel.

Why do it in hivi

Related Ontario forms repeat the same personal details. Captured once in hivi — stored in Canada, with AI on its own servers — every form starts mostly complete.