OHIP billing resources
Guides for Ontario physicians on remittance advice, uncorrectable OHIP error codes, and which rejected claims are not worth resubmitting.
OHIP Billing Cheat Sheet for Ontario Physicians
Free OHIP billing simulator for Ontario physicians. Choose your discipline, pick the visit, tick what you did, and get the highest-paying code combination the Schedule of Benefits allows.
FHO+ billing guide 2026: hourly codes, capitation, shadow billing and continuity of care
How FHO+ pays Ontario family physicians from April 2026: capitation, Q310A–Q313A hourly codes, 30%/50% shadow billing, Q012A at 50% and continuity of care.
How to read your OHIP remittance advice
What's on your monthly OHIP remittance advice, how to match it to your claims, what the codes mean, and what to do when OHIP pays less.
OHIP claim rejections in 2026: the most common errors and missed premiums
72,500 rejected OHIP claim lines from 223 billing numbers, January to September 2026: health card errors led, and the missed Q012A premium cost most.
Ontario preventive care bonus 2026: targets, codes and who's eligible
Ontario preventive care bonus: target populations, Q100A–Q123A tiers and amounts, tracking and exclusion codes, FHO/FHN limits and how to claim.
Stale-dated OHIP claims and RAIs: the 3-month rule, VJ7 and how to recover them
OHIP's 3-month submission limit and VJ7, how to resubmit claims first sent on time, and when to send an RAI within 7 months instead.
FHO+ Continuity of Care (COC) explained
Under FHO+, at least 75% of your enrolled patients' visits must be with you. Two linked quarters below 75% cost you 15% of a quarter's capitation.
How to add APEX to your iPhone Home Screen
Save APEX to your iPhone or iPad Home Screen from Safari in a few taps. It opens full screen like an app, with no App Store download.
How to setup OBS BPS secure designation
Add Verismo AI as your GoSecure designee, grant the required OPS BPS permissions, and APEX will verify access automatically.
OHIP Billing Submission Cut-off Dates Schedule
The Ministry publishes an early monthly deadline, but recent remittance files show that claims have continued into a later billing window. This calendar shows both dates.
E078A Chronic Disease Premium Diagnostic Codes
E078A only pays when the claim carries one of the OHIP-listed chronic disease diagnostic codes, and the diagnosis is already established.
FHO+ Capitation Rates by Age and Sex (April 2026)
Note: The value of the base rate payment shall be increased periodically as determined through the physician services agreement.
FHO+ Long-Term Care Base Rate Fee Codes (April 2026)
Schedule 2A codes sit in the FHO+ long-term care base rate of $1,223.22 per enrolled LTC patient per year, plus 30% or 50% shadow billing.
Update: Apr 2026 FHO+ In Basket codes
FHO+ pays 30% shadow billing on Schedule 2 core services. Schedule 2B procedures get another 20%, for 50% total.
OHIP error codes that usually don’t need correcting
Seeing an unfamiliar code on your remittance can be frustrating. These codes usually mean OHIP has already processed or adjusted the claim, so resubmitting it will not help.
Common OHIP billing questions
How do I start billing OHIP as a new grad?
Here is how to start billing in Ontario, and how to bill OHIP the first time. Apply to the Ministry of Health for an OHIP billing number, then register for GO Secure so you can use MCEDT, the Ministry's system for sending claims and receiving reports.
Then choose billing software or a billing agent, add it as your designee in GO Secure, and submit your first claims before the monthly cut-off. New grads can ask their residency program or the OMA for help with the application.
How GO Secure designation works · OHIP cut-off and payment dates 2026
How do I find my OHIP billing number?
Your billing number is on the Ministry's registration letter and on every remittance advice you receive. There is no public OHIP billing number lookup, and the number on the CPSO register is your CPSO number, which is a different number. The Ministry's Service Support Contact Centre can confirm yours.
Is there an OHIP billing course?
Colleges run OHIP billing courses for medical office staff. For physicians, the free OHIP billing cheat sheets, code pages and error code guides here cover the same ground, specialty by specialty.
How do I read my OHIP remittance advice?
Here is how to read OHIP remittance advice. The remittance advice (RA) is the Ministry's monthly statement of what it paid on each claim. Each line shows the claim and the amount paid and, when OHIP paid less or nothing, a two-character explanatory code.
Look those OHIP remittance advice codes up in the error code list to see why. APEX reads your RA from MCEDT and lists every claim with what was paid and why.
OHIP error and explanatory codes
What is FHO+ and how does FHO+ hourly billing work?
FHO+ is Ontario's updated Family Health Organization model, in effect since April 1, 2026. Physicians bill their time with four hourly codes in 15-minute units: Q310 (direct patient care), Q311 (phone care away from the clinic), Q312 (indirect care for a patient) and Q313 (clinical administration).
FHO+ shadow billing (the blended fee-for-service premium) pays 30% of the fee for in-basket services to enrolled patients, or 50% for specific in-basket services (INFOBulletin 260308). Each billing code page says whether the code is one of the FHO in-basket codes.
FHO+ shadow billing fee codes · Q310 FHO+ direct patient care
What is FHO+ continuity of care, and what happened to the access bonus?
On April 1, 2026, outside use and access bonus payments ended for FHO physicians (INFOBulletin 260308). FHO+ measures continuity of care (CoC) instead: the share of your enrolled patients' in-basket visits that you, your group or an accepted physician provide, tied to your FHO base rate payment. The target is 75%.
The Ministry still sends the Outside Use Report through MCEDT for patients with signed consent.
What are the FHO capitation rates for 2026?
Capitation is the yearly amount the Ministry pays for each enrolled patient, paid monthly and adjusted for the patient's age and sex. The April 2026 FHO+ annualized capitation payment rates are listed in our capitation rates article.
FHO+ capitation rates, April 2026
FHG vs FHO: which pays more? Is there an FHO+ calculator?
It depends on your roster size, visit volume and hours. APEX's Group Switch Analysis works as an FHO+ calculator: it estimates your income under FHO, FHG, the Comprehensive Care Model (CCM) and FHO+ side by side, from your own billing.
What are the FHO after-hours requirements?
FHO groups agree to offer a number of after-hours sessions each week, set by the group's size in its agreement. After-hours visits with enrolled patients add the Q012 after-hours premium, which rose from 30% to 50% for FHO physicians on April 1, 2026.
How does the preventive care bonus work in Ontario?
Preventive care bonuses pay enrolment-model physicians for reaching coverage targets in five areas: influenza, childhood immunization, cervical screening (Pap), mammography and colorectal screening. Since 2024–25, FHO and FHN physicians earn only the influenza (Q100A–Q104A) and childhood immunization (Q115A–Q117A) bonuses; the other three are reported for information only (INFOBulletin 240503).
The Ministry sends a Target Population/Service Report. You then claim the cumulative preventive care bonus with the preventive care bonus codes for the level you reached, before the June cut-off. Rosters under 1,000 enrolled patients are prorated. APEX reads the report from MCEDT and shows where you stand on each target.
What is an OHIP billing audit, and can underbilling be fixed?
The Ministry can review paid claims after the fact and recover payments that didn't meet the Schedule of Benefits, so every claim should match its code's rules. Underbilling is the opposite: services billed below what they qualified for. APEX's claim adjustments find paid claims billed below what they qualified for, for you to approve before anything is sent.
What about WSIB and out-of-province patients?
WSIB billing codes for physicians are set by the WSIB, and those claims go to the WSIB, not OHIP. Ontario physicians bill patients from other provinces (except Quebec) to OHIP through reciprocal medical billing (RMB), and those claims come back on your OHIP remittance and error reports like any other.
Is there an OHIP billing codes PDF?
Yes: the Ministry publishes the Schedule of Benefits (Ontario) as a PDF on ontario.ca. Our OHIP billing codes list has every code from it, searchable, including the new billing codes for 2026 such as Q310 to Q313.
Is there an OHIP diagnostic codes PDF?
The Ministry's OHIP diagnostic codes PDF is on ontario.ca. Our diagnostic code list has the same codes, searchable by code or symptom.
Where are OHIP billing codes by specialty?
The cheat sheets list OHIP billing codes for family medicine, emergency medicine, internal medicine, pediatrics and psychiatry (OHIP billing for 22 specialties), plus the hospitalist billing codes for hospital and long-term care visits.
What does an OHIP error code mean?
Each OHIP error code page says what happened and what to do, for example OHIP error code AT3 (virtual care with no existing patient-physician relationship) and V22 (diagnostic code not valid).