Sign IHP electronic claims undertakings without retyping provider and organization details

Interdisciplinary health providers enrolling in Electronic Data Transfer must complete an undertaking that repeats organization name, billing identifiers, and authorized representative contact information. 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): IHP Electronic Data Transfer (EDT) Undertaking and Acknowledgement — 014-4749-84

What this form is about

Form 014-4749-84 is the IHP Electronic Data Transfer (EDT) Undertaking and Acknowledgement, required when IHPs agree to ministry rules for transmitting OHIP claims electronically.

Before you start: what to gather

• Provider or group legal name and business address.
• IHP billing number and related identifiers.
• Authorized representative name and contact details.
• EDT vendor or software information — confirm on ontario.ca.

Confirm the current process on ontario.ca.

How hivi makes it faster

1. Save it once. Store your organization name 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.