OHIP error codes

Look up OHIP error and rejection codes from remittance advice and explanatory reports, and what they mean for unpaid claims.

• Articles
• Billing codes
• Error codes
• Diagnostic codes
• Specialty codes
• Relativity rates

About OHIP error codes

OHIP error codes say why a claim was rejected or paid differently. Three-character codes (EH2) come on the error report; two-character codes (35) on the remittance advice.

Each page says what happened and what to do. OHIP stale-dated claims (VJ7, over three months old) can still be paid through the Ministry's stale-dated process.

Read which OHIP error codes usually don’t need correcting.

OHIP error codes with a fix guide

• 09: The fee code used isn't correct for the service. Resubmit with the right code, or send an RAI if the claim is already on your Remittance Advice.
• 30: OHIP paid $0 for this line because it isn't an insured benefit. On $0 tracking codes and virtual-visit indicators this is normal.
• 31: OHIP didn't accept this as a valid network service. Check the patient's enrolment and the network billing before sending an inquiry.
• 32: OHIP already has a claim for services for this patient on this day. Check for a duplicate before sending anything again.
• 33: OHIP approved this claim. It's an informational code; there is nothing to fix.
• 35: OHIP already has a claim for this patient, service and date, so this one wasn't paid. Find the original before doing anything.
• 36: OHIP didn't pay this claim because its records show another physician, group or lab already billed the same service. Find out who before acting.
• 37: This lab code has a listed benefit of 0 laboratory medicine (LMS) units, so it pays $0. There is nothing to correct.
• 40: Code 40 means OHIP allows this service, or a related one, only once for the patient, and it was already paid. Find the earlier claim before doing anything.
• 41: Code 41 means the documents sent with the claim didn't support the fee code billed, so it wasn't paid as billed. Check them against the code's requirements.
• 42: Code 42 means the fee code billed is part of another procedure on the claim, so OHIP didn't pay it separately. Check what the main procedure includes.
• 45: The fee code can only be paid to certain specialties, and the specialty on the claim isn't one of them.
• 46: A Ministry medical advisor reviewed the claim a second time and approved payment. No action needed.
• 47: A Ministry medical advisor reviewed the claim a second time and decided not to pay it.
• 48: OHIP paid the claim as submitted, but may ask for your clinical records to check it. Keep the records on file.
• 49: OHIP paid this service at its average fee instead of pricing it from your records. Send the clinical or operative records if you want it reconsidered.
• 50: OHIP paid this line at the amount the Schedule of Benefits allows. It's a payment note, not a rejection; check only if the amount looks wrong.
• 51: OHIP paid this line under a different fee code from the one you billed, because the Schedule of Benefits calls for that code. Check which code was paid.
• 52: A Ministry medical consultant reviewed this claim and set the payment. To dispute it, send an inquiry with the clinical records, not a new claim.
• 53: OHIP paid this line under an earlier edition of the Schedule of Benefits that applied on the service date.
• 54: OHIP made an interim payment while the claim is under review. Wait for the review to finish before acting.
• 55: OHIP took back money paid on an earlier claim, usually because it reprocessed that claim. Check it against its matching 57 line first.
• 56: OHIP is reviewing this claim. Don't resubmit; wait for the decision on a later remittance advice.
• 57: OHIP paid more on an earlier claim, usually after reprocessing it. It often comes paired with a 55 deduction; check the net amount.
• 58: OHIP didn't pay this because another physician in your group already claimed the service. Sort out who provided it before doing anything.
• 59: This claim relates to a WSIB (formerly WCB) case. OHIP is notifying you that the service is a Workers' Compensation matter.
• 60: The service isn't covered under the Reciprocal Medical Billing agreement for out-of-province patients, so OHIP didn't pay it.
• 62: An OHIP Assessment Officer assessed this claim and set the payment. It's informational unless the amount looks wrong.
• 65: Code 65 means OHIP didn't pay this fee because hospital funding covers the service. Check where it was done and whether the patient was admitted.
• 66: Payment was reduced under an Alternative Payment Program (APP) funding contract that covers this service.
• 69: OHIP paid this elective service at 75% of the OHIP schedule of rates.
• 70: OHIP didn't pay this because another physician had already claimed a corresponding procedure for the patient that day. Find the other claim first.
• 80: OHIP adjusted the technical fee for a service done in hospital. Check the amount against the hospital rules.
• A14: OHIP shows this service was already provided by another practitioner, group or IHF, so the claim was rejected.
• A1A: The service date is outside the period OHIP allows for this service, so the claim was rejected.
• A2A: A2A means the patient is too young or too old for the fee code billed. Bill the age-appropriate code and resubmit.
• A2B: The fee code isn't normally done for the patient's sex on OHIP's records. Check the patient's details and the code.
• A34: OHIP received this claim more than once. Find the original before sending anything again.
• A36: Another practitioner already claimed this service for the patient, so OHIP rejected yours.
• A3E: A3E means the fee code wasn't valid on the service date: it had already ended, or hadn't started yet. Check the code's dates and bill the code that applied.
• A3F: The fee code has no fee on the service date. Check the code is valid for that date and the right one for the service.
• A3G: The fee billed is lower than the Schedule fee for this code. Bill the current Schedule amount and resubmit.
• A3H: A3H means the claim billed more services of a fee code than OHIP allows. Reduce the number of services to the allowed limit and resubmit.
• A3I: A3I means the claim billed more services of an X-ray code than OHIP accepts for that code. Correct the number of services and resubmit.
• A3L: Another new patient fee has already been paid for this patient, so this one was rejected.
• A4D: A4D means the fee code billed can't be paid to the specialty code on the claim. The code is limited to other specialties.
• AC1: The fee code's maximum has been reached. Resubmit with the alternate fee code the Schedule allows for later services.
• AC4: AC4 means OHIP did not accept the referring provider number on the claim. It may be missing, not six digits, or not allowed for this fee code.
• AD3: This service can't be paid together with the visit billed on the same claim. Remove one or bill the right combination.
• AD5: OHIP has already allowed this procedure for the patient, so the claim was rejected.
• AD8: This fee code can't be billed on its own. Add the service it must be billed with, or remove it.
• AD9: A premium was billed without the service it must go with. Add the base service, or remove the premium, and resubmit.
• ADF: The procedure this code depends on is missing, invalid or paid at $0. Fix the related procedure and resubmit.
• ADH: These fee codes can't be billed together. Keep the one the Schedule allows and resubmit.
• ADM: The claim breaks the rules for emergency department equivalent (A888) visits. Check what can be billed with or instead of A888.
• AEV: OHIP will only accept a visit fee for this service. Bill it as a visit rather than the code you used.
• AH: OHIP didn't pay this service because it was billed in addition to a health exam for the same patient. Check whether it was part of the exam.
• AH5: AH5 means the admission date on the claim doesn't match the Ministry's record of the hospital stay. Check the date and resubmit.
• AH8: AH8 means the admission date or hospital (master) number on an in-hospital claim is invalid or missing. Correct both and resubmit.
• AH9: AH9 means a diagnostic service for a hospital patient is covered by the hospital's budget, not paid fee-for-service. Usually there's nothing to fix.
• AHA: AHA means the fee code doesn't match the time period of the service. Check the time and day the service started and bill the code for that period.
• AHF: AHF means concurrent or supportive care was already claimed for this patient in the same period. Check the weekly limits before resubmitting.
• AM1: AM1 means the service is over its Schedule limit for this patient (per day or per period). Services over the limit aren't paid.
• AMR: AMR means the claim didn't meet the code's minimum requirements, such as a minimum time or number of services. Check the rules and bill to match.
• AMS: AMS flags a multiple-procedure conflict: procedures billed together for the same patient that can't be paid as billed. Review and resubmit.
• AO2: AO2 means an obstetrical service that is limited per pregnancy was already billed for this patient. Check what was paid before resubmitting.
• AO3: AO3 means an MRP visit for this hospital stay was already paid. If you weren't the MRP on that day, bill a regular subsequent visit.
• AP: OHIP paid this claim under the governing legislation. If you disagree, the Ministry's message says you may appeal to the General Manager.
• ARF: ARF means the claim needs a referring physician number and none was given. Add the referrer's billing number and resubmit.
• ARP: ARP means this fee code requires a referring physician number on the claim. Add the referrer's billing number, or bill a non-referral code.
• ASP: ASP means the service can't be paid with a surgical procedure billed for the same patient, because the surgical fee includes it.
• AT1: AT1 means the virtual care claim has more than one modality indicator. Keep only K300A (video) or K301A (phone) and resubmit.
• AT2: AT2 means a service that is only payable by video was billed without the K300A video indicator. Add K300A if the visit was by video.
• AT3: AT3 means OHIP rejected a comprehensive virtual care claim because it found no existing patient-physician relationship on the service date.
• AT4: AT4 means a virtual-care claim (K300A video or K301A phone) carries a tracking code that isn't allowed with a modality indicator.
• B1: OHIP paid $0 because the service was billed as a telephone visit (K301A) but is only payable by video. Check how the visit was actually done.
• B2: OHIP paid this telephone virtual visit at its telephone rate, which is lower than the in-person fee. It's a payment note, not a rejection.
• B3: OHIP didn't pay this comprehensive virtual service because no existing patient-physician relationship was found. Limited virtual care may apply.
• B4: OHIP didn't pay this virtual service because the same service was already paid in person for this patient. Often there's nothing to fix.
• B5: OHIP didn't pay this in-person service because the same service was already paid as a virtual service for this patient. Compare both claims.
• B6: OHIP didn't pay this virtual service because a limited virtual care service (A101 or A102) was already paid for this patient.
• B7: OHIP didn't pay this virtual service because a comprehensive virtual care service was already paid for this patient. Compare both claims.
• B8: OHIP didn't pay this line because the fee code can't be billed as a virtual service. Only codes listed in Appendix J are payable virtually.
• C1: OHIP paid this consultation at a lower fee: as a repeat or limited consultation, or a midwife-requested emergency assessment.
• C2: OHIP paid this line at a re-assessment fee instead of the amount or level billed. Compare the payment with the allowed fee.
• C3: OHIP paid this visit at the minor assessment fee instead of the fee code billed. Check the rule that applies before sending an RAI.
• C4: OHIP paid this consultation as an assessment because a consultation isn't payable with another service billed for the patient.
• C5: OHIP paid this emergency department assessment as a multiple systems assessment instead of the fee code you billed.
• C6: OHIP paid this long-term care admission assessment as a Type 2 admission assessment, because you saw the patient before admission.
• C7: OHIP didn't pay this admission assessment or re-assessment because a pre-operative or pre-dental assessment was done within the previous 30 days.
• C8: OHIP paid this comprehensive geriatric consultation at the regular geriatric consultation fee: the limit of one per 2 years was reached.
• C9: OHIP paid this claim as in-patient interim admission orders because another physician already claimed the initial admission assessment.
• CNA: CNA means counselling was billed with another service that can't be paid with it the same day, or didn't meet counselling rules. Review and resubmit.
• D1: OHIP paid this procedure at the repeat-procedure fee, because the initial procedure was already claimed for this patient.
• D2: OHIP paid the additional procedures at 50% because more than one procedure was billed. This is often expected.
• D3: OHIP won't pay this service on top of the visit fee billed with it, so the line was cut or paid $0. Check the visit total before acting.
• D4: OHIP paid this procedure at 50% because a visit was billed with it. Check the procedure's notes before sending an RAI.
• D5: OHIP had already paid a procedure for this patient, so it reduced the visit fee billed with it. Check the visit and procedure together before acting.
• D6: OHIP didn't pay this procedure, or paid less, because the payment limit for it was reached. Check the limit in the Schedule.
• D7: OHIP didn't pay this procedure because it isn't allowed with another procedure billed for the patient. Check the procedure notes.
• D8: OHIP didn't pay this code because it can only be paid with certain procedures, and none of them was billed with it.
• D9: OHIP didn't pay this service because it isn't payable to a hospital department. Check who should bill it.
• DA: OHIP paid this procedure at the repeat or chronic fee because the maximum for the initial procedure was reached.
• DB: OHIP didn't pay this dialysis claim because another dialysis service for the patient was already paid for the same period.
• DC: OHIP had already paid a related service, so it paid only the difference on this one. Usually nothing is owed; check the total for both services.
• DD: OHIP didn't pay this eye service because the diagnostic code isn't related to the original eye exam. Check the diagnostic code.
• DE: OHIP reduced the visit fee because lab tests for the patient were already paid. Check what the visit and the tests covered.
• DF: OHIP paid $0 for an add-on because the fee it must be billed with wasn't on the claim, or was itself paid $0. Fix the main service first.
• DG: OHIP didn't pay this line because diagnostic services for hospital patients are covered by the hospital's global budget, not paid fee-for-service.
• DH: DH explains a payment: OHIP allowed ventilatory support together with haemodialysis for the patient. There is usually nothing to fix.
• DL: DL explains a payment: the service was allowed as a laboratory test done in a physician's office. Usually nothing to fix.
• DM: OHIP applied its emergency department equivalent (walk-in or urgent care, weekend or holiday) rules, so the line was paid differently or not at all.
• DN: DN explains a payment: a pudendal block was allowed in addition to the procedure, per OHIP policy. Usually nothing to fix.
• DP: DP means an earlier procedure is now counted at 50% alongside this one, so OHIP paid only the difference on this line. Usually nothing to fix.
• DR: DR means OHIP paid this diagnostic service at 50% because it was treated as self-referred. Check the referring physician on the claim.
• DS: DS means this line wasn't paid because it can't be paid with another code billed for the patient. Check which code fits the service.
• DT: DT means the technical fee wasn't paid because the patient was a hospital in-patient. Only the professional component is payable.
• DV: This service is part of the long-term care monthly management fee (W010) paid for the patient this month, so it isn't paid separately.
• DW: DW: an earlier service for this LTC patient is part of W010, so OHIP reduced this payment by what it already paid. Usually nothing to fix.
• DX: DX means the diagnostic code on the claim isn't accepted with this fee code. Check the Schedule and use a diagnostic code that fits.
• E1: E1 means the service date is before the patient's OHIP coverage started. Check the service date and the patient's eligibility.
• E2: E2 means the health card version code on the claim wasn't valid for the service date. Get the right version code for that date.
• E3: E3 means the version code on the claim is not on file for that health number. Check the patient's card and correct the version code.
• E4: E4 means the service date is after the patient's OHIP eligibility ended. Check the date and the patient's coverage.
• E5: E5 means the patient had no OHIP eligibility on the service date (it falls between eligible periods). Check the date and coverage.
• E6: E6 means the Ministry's records show the patient died before the service date. Check the service date and health number.
• E9: E9 means the patient's coverage ended because they didn't respond to a Notice to Register. The patient needs to contact ServiceOntario.
• EA: EA warns the patient wasn't eligible on the service date. Services on or after the 20th of this month won't be paid unless that changes.
• EB: EB means OHIP added or changed coding on your claim to match the Schedule of Benefits. Check what changed and the amount paid.
• EE: EE explains a payment: the assessment was allowed at the full fee because the patient went on to hospital. Usually nothing to fix.
• EF: EF warns the version code on the claim is wrong. Services on or after the 20th of this month won't be paid without the current version code.
• EF1: EF1 means the ICHSC number on the claim wasn't approved to bill on the service date. Check the facility number and date.
• EF2: EF2 means the ICHSC wasn't licensed or grandfathered to bill this fee code on the service date. Check the facility's licence.
• EF3: EF3 means an insured service was billed on an ICHSC claim, which isn't allowed. Bill insured physician services separately.
• EF4: EF4 means the provider wasn't approved to bill ICHSC fees on the service date. Check the provider's approval and the date.
• EF5: EF5 means insured services were billed under ICHSC practitioner number 991000, which isn't allowed. Bill them under a physician's number.
• EF7: EF7 means this ICHSC fee needs a referring physician number on the claim. Add the referring physician's number and resubmit.
• EF8: EF8 means an 'I' service code was billed by someone other than an ICHSC. Only ICHSCs can bill I codes.
• EF9: EF9 means the claim needs a mobile site number. Add the mobile site number and resubmit.
• EG1: EG1 means the group on the claim isn't eligible. Check the group number used and the group's registration on the service date.
• EH1: EH1 means the service date is before the patient's OHIP coverage started. Check the date and health number before anything else.
• EH2: EH2 means the health card version code on the claim doesn't match the Ministry's record. Get the current version code and resubmit.
• EH4: EH4 means the patient's OHIP coverage had ended before the service date. Confirm the health number, then the patient's coverage.
• EH5: EH5 means the patient had no OHIP eligibility on the service date. Check the service date, health number and the patient's coverage.
• EH6: EH6 means the Ministry shows the patient as deceased before the service date. Check the date and health number on the claim.
• EH9: EH9 means the patient's health number isn't activated yet. The patient needs to contact ServiceOntario; resubmit once it's active.
• EN: EN means OHIP refused this line because network billing isn't allowed for it. Check your enrolment model and the code's rules.
• ENP: ENP means the fee code isn't valid for a nurse practitioner. Check the fee code and provider or referral number on the claim.
• EP: EP marks a payment adjustment on an earlier claim, made because your provider registration was updated. Usually nothing to fix.
• EP1: EP1 means OHIP refused an enrolment claim, most often a Q200A rostering claim, because it couldn't be accepted as submitted.
• EP2: EP2 means the claim can't be used for enrolment or re-enrolment. Check the enrolment code and the patient's current enrolment.
• EP3: EP3 means the service date doesn't fit the patient's enrolment date. Use the date on the signed enrolment form and resubmit.
• EP4: EP4 means an enrolment restriction stopped this claim. Check the patient's enrolment status before resubmitting.
• EP5: EP5 means this fee code isn't valid for your group's model type. Use the code that belongs to your patient enrolment model.
• EP6: EP6 means the patient's health number isn't activated, so the enrolment claim can't be processed. Resubmit once it's active.
• EP7: EP7 means this code has to be on a claim by itself. Move the other services to a separate claim and resubmit.
• EPA: EPA means the claim includes a code reserved for physicians in a primary care enrolment model, and you aren't approved to bill it under this number.
• EPC: EPC means the claim needs the patient to be enrolled to you or your group, but OHIP shows them not rostered or rostered to another group.
• EPD: EPD flags a discrepancy between the patient's roster and a payment. Check the patient's enrolment before resubmitting.
• EPF: EPF means the claim's date doesn't match the patient's enrolment date. Check the date on the enrolment form and resubmit.
• EPP: EPP means the code doesn't match the patient's Ontario Works or ODSP eligibility. Use the code for the program the patient is on.
• EPS: EPS means the patient isn't eligible for the program the code belongs to. Check the code's eligibility rules before resubmitting.
• EQ1: EQ1 means the billing practitioner isn't registered with OHIP. Check the billing number on the claim and the registration.
• EQ2: EQ2 means the specialty code on the claim isn't one the physician has registered and active with the Ministry on the service date.
• EQ3: EQ3: the claim was sent as pay patient, but you are registered as opted in on that date. Change the payee to pay provider and resubmit.
• EQ4: EQ4: the claim was sent as pay provider, but you are registered as opted out on that date. Change the payee to pay patient, or check your registration.
• EQ5: EQ5 means the laboratory number on the claim was not active with the Ministry on the service date. Check the lab number and date, then resubmit.
• EQ6: EQ6 means the referring or requisitioning provider number on the claim isn't registered with the Ministry. Correct the referral number and resubmit.
• EQ9: EQ9 means the laboratory number on the claim isn't on the Ministry's file. Check the lab number and resubmit.
• EQB: EQB means the solo billing number on the claim wasn't active, or can't bill solo, on the service date. Check registration and how the claim was billed.
• EQC: EQC means the group number on the claim isn't registered with the Ministry. Check the group number and resubmit.
• EQD: EQD means the group number on the claim wasn't active with the Ministry on the service date.
• EQE: EQE means the physician on the claim isn't registered with the Ministry as a member of the group whose number was used.
• EQF: EQF means the physician is on file as a member of the group on the claim, but the membership wasn't active on the service date.
• EQG: EQG means the referring laboratory number isn't registered with the Ministry. Check the referring lab number and resubmit.
• EQI: EQI is a contract characteristics error: the claim doesn't fit your registration or payment agreement on the service date. Check your registration.
• EQJ: EQJ means you weren't eligible for this new patient fee on the service date: the new graduate and regular new patient fees were mixed up.
• EQK: EQK means the master number on the claim doesn't meet the criteria for the fee. The Ministry's example is A100 billed with a specialty other than 00.
• EQL: EQL means you aren't eligible for this fee code. The Ministry's example is A100 billed by a non-00 specialty or under an ED funding agreement group.
• EQM: EQM means you aren't registered with the Ministry to use this fee code or program. Confirm your registration before resubmitting.
• EQN: EQN means your registration for this service wasn't in effect on the service date. Check the dates of your registration.
• EQP: EQP means the patient's enrolment type isn't eligible for this fee code. Check how the patient is enrolled and the code's rules.
• EQS: EQS means you don't meet the practitioner criteria for this fee code on the service date. Check the code's eligibility rules.
• ERF: ERF means the referring physician number on the claim is currently not eligible to refer. Check the referring number and resubmit.
• ESD: ESD means the emergency department was under an alternative funding agreement on the service date, so the claim isn't payable as billed.
• ESF: ESF means the provider isn't eligible to bill this service. Check the billing number, specialty and the fee code's rules.
• ESH: ESH means the claim was sent without a health number, but you aren't eligible to submit blank health number claims. Add the health number.
• ESN: ESN means the claim was sent without a health number, but this fee code isn't one that can be billed without one. Add the health number and resubmit.
• ET1: ET1 means the claim was billed as telemedicine, but you aren't registered for telemedicine. Check how the visit should be billed.
• ET4: ET4 means a telemedicine claim is missing its telemedicine premium or tracking code. Check how the visit should be billed.
• ET5: ET5 means a claim had a telemedicine tracking code, but the service location indicator was missing or not OTN. Check how the visit should be billed.
• EV: EV on your remittance advice is a reminder that the patient's health card version code may be out of date. Update it before the next claim.
• F1: F1: with more than one fracture or dislocation, the major one is paid at 100% and each other one at 85%. This is a standard reduction.
• F2: F2: the fracture fee was paid at the transferred-care rate because another physician took over after-care. This is a standard reduction.
• F3: F3: an earlier reduction attempt on the same fracture or dislocation was paid at 85%. The final reduction gets the full fee. Usually correct.
• F5: F5: visits in the two weeks after fracture treatment are included in the fracture fee, so they weren't paid separately.
• F6: F6: the assessment was paid at the minor or partial assessment fee instead of the code you billed. Check the record supports the higher level.
• FF: FF marks an extra payment OHIP made on a claim shown on the RA. It is informational. Nothing needs to be fixed.
• G1: G1: critical, ventilatory or comprehensive care fees were already paid for this patient that day, so this critical care code wasn't paid.
• GF: GF: the patient's OHIP coverage has lapsed. Ask them to contact ServiceOntario. Future services may have to be billed to the patient.
• H1: H1: an admission or emergency department assessment was already paid for this patient, so this one was reduced or not paid.
• H2: H2: an initial visit was already claimed for this patient, so this one was paid as a subsequent visit. Usually correct.
• H3: H3: after the 5th week in hospital, subsequent visits are limited per week. Visits over the limit weren't paid. Use C121 for acute intercurrent illness.
• H4: H4: after the 6th week in hospital, a weekly maximum applies to paediatricians' visits. Visits over the limit weren't paid.
• H5: H5: after the 13th week in hospital, subsequent visits are limited per month. Visits over the limit weren't paid. Use C121 for acute intercurrent illness.
• H6: H6: the hospital visit was paid as supportive or concurrent care instead of the code billed. Check your role in the patient's care.
• H7: H7: the visit was paid as chronic care, not at the code you billed. Check the type of bed or institution the patient was in.
• H8: H8: an in-hospital service needs the hospital (master) number and/or the admission date on the claim. Add the missing details.
• H9: H9: another physician has already claimed concurrent care for this patient, so this concurrent care claim wasn't paid.
• HA: Another physician was already paid the admission assessment for this hospital stay, so your claim was paid at a hospital visit fee instead.
• HB: HB: a subsequent hospital visit was already paid for this patient that day, so this one wasn't paid. Use C121 for acute intercurrent illness.
• HCC: HCC means Health Care Connect requirements for the new patient fee weren't met: the patient isn't on HCC as complex-vulnerable in 'referred to' status.
• HCE: HCE means the patient was enrolled to you more than 3 months after the Health Care Connect 'referred to' date, so the HCC new patient fee isn't payable.
• HF: HF: concurrent or supportive care was already claimed for this patient in the period, so this visit wasn't paid. The weekly limits apply.
• HM: HM: the hospital (master) number on the claim wasn't valid on the service date. Check the master number for the facility.
• I2: I2 means the service is already funded through your capitation model, so OHIP doesn't pay the full fee. It's normal shadow billing, not a rejection.
• I3: I3: the fee code isn't on the facility's licence profile (formerly IHF, now ICHSC) for the service date, so it wasn't paid.
• I4: I4 means OHIP has already paid this service to another physician, group or facility. Check who billed it before asking for a review.
• I5: I5 means the service is covered by global (facility) funding and the fee code isn't on the facility's licence profile, so it isn't paid fee-for-service.
• I6: OHIP refused a premium on this claim because the premium's conditions weren't met. Check whether the main service was still paid.
• I7: I7 means the service date on the claim doesn't match the patient's enrolment date. Check the date on the enrolment form and ask for a review if needed.
• I8: I8 means OHIP did not receive a confirmation it needed to pay this line. Find out what confirmation applies and ask for a review.
• I9: I9 means the payment or premium on this line doesn't apply or has expired. Check the code's eligibility period before asking for a review.
• IA: OHIP refused a premium because it can't be paid with the fee code it was billed with. Check the premium's list of eligible codes.
• J1: J1 means the service date is before the patient's OHIP coverage started. Check the health number and date, or have the patient contact ServiceOntario.
• J2: J2 means the service date is after the patient's OHIP coverage ended. Check the health number, or have the patient contact ServiceOntario.
• J3: J3 is good news: the Ministry approved this claim for stale-dated processing even though it was older than three months. No action needed.
• J5: J5 means the patient applied for coverage but the Ministry shows premiums as not yet paid. Advise the patient to contact ServiceOntario.
• J7: J7 means the claim reached OHIP more than three months after the service date. Use the stale-dated process only if it was first sent on time.
• J8: J8 warns that the patient's coverage isn't in effect. Services on or after the 20th of this month won't be paid unless the patient fixes it.
• J9: J9 means the patient's OHIP coverage has been reinstated. Submit their claims as usual.
• L1: L1 means this lab service was already paid to another laboratory, so it isn't paid again. Check which lab did the test.
• L2: L2 means this service isn't payable to the medical laboratory director. Check who should bill it.
• L3: L3 means this lab procedure can't be paid on top of another lab procedure already billed. Check the pairing rules.
• L4: L4 means this lab service isn't payable to the attending physician. It is billed by the laboratory instead.
• L5: L5 means this procedure can't be paid on top of another procedure already paid to a different lab.
• L6: L6 means a related procedure was already paid to another lab, so this fee was reduced to pay only the difference.
• L7: L7 means the service isn't payable because the specimen was referred to another lab. The lab that did the test bills it.
• L8: L8 means this service can't be claimed with a prenatal or fetal assessment.
• L9: L9 means lab services for hospital in-patients or out-patients aren't paid fee-for-service. They are covered by the hospital's global budget.
• LA: LA means the lab service is funded by a special lab agreement, so it isn't paid fee-for-service.
• LS: LS means the service was paid under a special lab agreement. Check the amount against the agreement's terms.
• M1: M1 on your remittance advice means OHIP already paid the maximum for this service, to you or another provider, so the line was reduced or not paid.
• M2: M2 means the maximum for these X-ray examinations was already reached, by you or another physician. Check what was already paid.
• M3: M3 means the maximum fee for prenatal care has been reached for this pregnancy. Check prenatal visits already paid.
• M4: M4 means the maximum for these services has been reached, counting claims by you and other physicians. Check what was already paid.
• M5: M5 means the monthly maximum for this service has been reached. Check what was already paid for the patient that month.
• M6: M6 means the special visit premium limit for that time period was reached, so this extra patient's premium wasn't paid.
• MA: MA means the maximum number of sessions for this service has been reached. Check the code's session limit.
• MC: MC means the patient already has the maximum case conferences paid in 12 months, usually 4 per patient per physician.
• MD: MD means the claim went over a daily maximum in the Schedule of Benefits, so services over the limit weren't paid. Check the code's per-day limit.
• ME: ME means the maximum number of e-assessments for this patient or physician has been paid. Check the e-assessment limits.
• MM: MM means the claim doesn't meet the Schedule of Benefits requirements for that fee code. Check the code's requirements and your records.
• MN: MN means the patient has reached the maximum occipital nerve block sessions. More first blocks need independent consideration (G291).
• MO: MO means the patient has reached the maximum OCT (optical coherence tomography) services for the period. Check the OCT limits.
• MR: OHIP paid $0 because the minimum services this code depends on weren't found. For family physicians it is usually Q040A without enough K030 visits.
• MS: MS means the maximum sleep studies for this period was reached, by you or another physician. More need MOH prior approval.
• MU: MU means more units were billed than the code allows. Check the code's unit limit and your time records.
• MW: MW means too many weeks have passed since the first service in a series was paid. Check the code's time window.
• MX: MX means the maximum of two arthroscopy R codes with the E595 add-on was reached.
• MY: MY means the yearly maximum for this service has been exceeded for the patient. Check the code's limit and what was paid.
• O1: O1 means the obstetric care fee was split between providers. Check that your share matches the care you gave.
• O2: O2 means prenatal care for this pregnancy was already claimed, so this service isn't paid as billed.
• O3: O3 means another doctor already claimed prenatal care for this pregnancy. Check whether care was transferred.
• O4: O4 means pregnancy-related office visits before delivery were treated as included in the obstetric fee.
• O5: O5 means this service isn't payable in addition to the delivery fee. Check what the delivery fee includes.
• O6: O6 means medical induction or stimulation of labour is paid once per pregnancy, to one physician. It was already paid.
• O7: O7 means the initial prenatal visit was already claimed, so this visit was paid as a subsequent prenatal visit.
• O8: O8 means this service can only be paid once per pregnancy and OHIP has already paid it. Check for an earlier claim before sending an RAI.
• O9: O9 means the visit is included in post-natal care already paid. Routine postpartum visits in hospital or home are part of P007.
• P2: P2 means the maximum payable for low birth weight care has been reached for this baby. Check earlier paid claims before sending an RAI.
• P3: P3 means newborn care was already paid for this baby. Newborn care is limited to one per patient unless the baby moved to another hospital.
• P4: P4 means newborn or low birth weight care can't be paid alongside neonatal intensive care for the same baby. NICU fees include the assessments.
• P5: P5 means the patient was over the age limit for paediatric payment rates on the service date. Check the date of birth and the code billed.
• P6: P6 means the child was past the age for well-baby care, which covers the first two years of life. Bill an age-appropriate visit instead.
• P8: P8 means the patient was enrolled more than 3 months after their Health Care Connect referral, so the HCC new-patient fee isn't payable.
• P9: P9 is the Ministry's 'Complex New patient' message. It relates to the Health Care Connect complex/vulnerable new patient fee.
• PA1: PA1 means a Physician Assistant (PA) Pilot claim mixed PA tracking codes with other OHIP fee codes. Split them and resubmit.
• PA2: PA2 means a Physician Assistant Pilot claim didn't name the supervising physician's solo billing number in the Refer Physician field.
• PA3: PA3 means a billing number on the PA Pilot claim isn't affiliated with the PA Pilot group. Check the numbers, or confirm the registration.
• PA4: PA4 means the Physician Assistant Pilot registration wasn't in effect on the service date. Check the date and the registration period.
• PA5: PA5 is a Physician Assistant Pilot affiliation error: the billing numbers on the claim don't match a valid PA Pilot affiliation.
• PA6: PA6 means the Physician Assistant Pilot affiliation wasn't in effect on the service date. Check the date and the affiliation period.
• PAA: PAA means OHIP found no E079 smoking cessation initial discussion paid in the 365 days before this K039 or Q042A, so it rejected the claim.
• PM: PM means your roster was below the minimum size needed for this payment, such as the FHG/CCM preventive care bonuses (650 patients).
• Q7: Q7 means OHIP doesn't pay a fee for treating a member of the physician's immediate family. No correction will make this payable.
• Q8: Q8 means the laboratory wasn't licensed to perform this test on the service date, so OHIP didn't pay it.
• R01: R01 means a Reciprocal Medical Billing (out-of-province) claim had no health service number. Add the patient's home-province number and resubmit.
• R02: R02 means the out-of-province health service number on a Reciprocal Medical Billing claim isn't valid. Check it against the card and resubmit.
• R03: R03 means the province code on a Reciprocal Medical Billing claim is missing or invalid. Enter the two-letter code of the patient's home province.
• R04: R04 means the service can't be billed through Reciprocal Medical Billing. Bill the patient or their home province directly.
• R05: R05 means the province code (ON or Quebec) can't be used for Reciprocal Medical Billing. Ontario patients are billed with their OHIP number.
• R06: R06 means the billing provider isn't valid for Reciprocal Medical Billing. Check the billing number on the out-of-province claim.
• R07: R07 means the payment type on a Reciprocal Medical Billing claim is invalid. RMB claims must be paid to the provider (payee P).
• R08: R08 means the referring physician number on a Reciprocal Medical Billing claim is invalid. Correct it, or remove it if no referral applies.
• R09: R09 means a Reciprocal Medical Billing claim was sent without its second claim header (the patient record). Rebuild the claim as RMB.
• R1: R1 means OHIP already has a health exam for this patient in the past 12 months, so this periodic health visit wasn't paid.
• R2: R2 means the limit of 10 well-baby visits before age two has been reached. Further visits need an assessment for a specific problem.
• R3: R3 means only one well-child exam (age 2 to 5) is allowed in a 12-month period, and one was already paid.
• RD: RD means this service was already paid through Reciprocal Medical Billing (out-of-province billing), so OHIP won't pay it again.
• S1: S1 means a one-stage bilateral procedure was paid at the unilateral fee plus 85% for the second side. This is the standard bilateral rule.
• S2: S2 means a two-stage bilateral procedure was paid at the unilateral fee plus 85% for the second stage, under the Surgical Preamble rule.
• S3: S3 means OHIP paid this procedure at 85% because it was a second procedure under the same anaesthetic or stay for the same condition. This is normally correct.
• S4: S4 means a procedure fee was reduced because it was paid with a related surgery or anaesthetic on the same claim or day.
• S5: S5 means this service is not paid in addition to a major surgical fee. It is treated as part of the surgery.
• S6: S6 means the initial procedure was already claimed, so this one was paid as a subsequent procedure at the lower fee.
• S7: This visit was routine pre-operative or post-operative care, which OHIP counts as part of the surgical fee, so it wasn't paid separately.
• S9: S9 means OHIP couldn't find the initial procedure that this follow-up or subsequent procedure depends on.
• SA: SA means the surgical procedure was paid at the consultation fee, as the Surgical Preamble allows when the surgical fee is lower.
• SB: SB means a normal pre-operative visit is included in the surgical fee. The visit was already paid, so the surgical fee was reduced.
• SC: SC means a major pre-operative visit was already claimed for this surgery, so this one wasn't paid.
• SD: SD means the team or assistant fee for this procedure was already claimed, so this claim wasn't paid.
• SE: SE means both a major pre-op visit and an admission assessment were paid, so the surgical fee was reduced by the admission assessment.
• SF: SF means an MRP visit isn't allowed during the post-operative period, so the surgical fee was adjusted. Post-op care is part of the surgery.
• SN: SN means more than one anaesthetic was claimed for the same patient on the same day. Documentation of separate surgeries is needed.
• SV: SV means an MRP visit isn't allowed during the post-operative period, so it was paid at the ordinary subsequent visit fee.
• SW: Another physician was paid an ICU per diem for this patient, so your MRP visit was paid at the ordinary subsequent visit fee.
• SX: Another physician was paid an ICU per diem for this patient, so the MRP premium on your visit (such as E083 or E084) was not paid.
• T1: OHIP set this line's payment to match the surgeon's claim for the same operation. Compare your claim with the surgical claim before querying it.
• TM1: TM1 means a telemedicine claim for the same patient and service was already submitted. Check for a duplicate before doing anything else.
• TM2: Telemedicine services can't be billed for missed, cancelled or abandoned appointments. Don't resubmit unless the service actually took place.
• TM3: The service billed isn't payable under the telemedicine program. Check the code; current virtual visits follow the Appendix J virtual care rules.
• TM4: A non-telemedicine claim was already paid for this patient for the same service. Check whether both claims cover the same encounter.
• TM5: A telemedicine claim was already paid for this patient for the same service. Check your RA before resubmitting.
• TM6: The telemedicine registration wasn't in effect on the service date. Check the registration dates before resubmitting.
• TM7: Dental services aren't eligible for telemedicine. Bill the service as delivered in person, or not at all.
• TM8: The service isn't eligible to be billed as store-and-forward. Check the fee code and how the service was delivered.
• V02: The region code on the claim isn't valid. Correct it and resubmit.
• V05: The claim number is earlier than the service date, so the claim was rejected. Fix the dates or numbering and resubmit.
• V06: The clinic code on the claim is incorrect. Check it against your registration and resubmit.
• V07: The billing (practitioner) number on the claim isn't valid. Check the number and resubmit.
• V08: V08 means the specialty code on the claim is missing, invalid, or doesn't fit the provider number. Correct the specialty code and resubmit.
• V09: The referring physician number on the claim isn't valid. Check the 6-digit number and resubmit.
• V1: An initial assessment was already paid within the limit for this patient, so this one was paid at the lower repeat (re-assessment) fee.
• V10: The patient's last name is missing or contains characters other than letters. Correct the name and resubmit.
• V12: The patient's first name is missing or contains characters other than letters. Correct the name and resubmit.
• V13: The patient's date of birth is missing or not a valid date. Enter it as 8 digits and resubmit.
• V14: The patient's sex must be 1 (male) or 2 (female) on this claim. Correct the field and resubmit.
• V16: V16 means OHIP could not accept the diagnostic code on the claim, usually because it isn't in the plain numeric form OHIP requires.
• V17: The payee field must be P (pay provider) or S (pay patient). Correct it and resubmit.
• V18: The admission or first visit date on the claim isn't valid. Check the date and resubmit.
• V19: The chiropractic diagnostic code on the claim isn't valid. Correct the code and resubmit.
• V2: Only the first patient seen on a home visit gets the home premium or A900. This patient was paid as an extra patient seen in the same home.
• V20: V20 means the diagnostic code doesn't fit the patient's age, usually well-baby dx 916 after age 2 or dx 917 on A003 under 16.
• V21: This fee code needs a diagnostic code, and the claim had none. Add the 3-digit diagnostic code and resubmit.
• V22: V22 means the diagnostic code on the claim is not a valid OHIP diagnostic code. Replace it with a code from the Ministry's list and resubmit.
• V23: V23 means OHIP questioned the number of services. It usually means a B- or C-suffix fee code was billed with only one service.
• V28: V28 means the hospital (master) number on the claim isn't a valid four-digit facility number. Correct it and resubmit.
• V29: The in-patient/out-patient indicator on the claim isn't valid. Correct it and resubmit.
• V3: V3 means OHIP didn't pay the visit on top of the procedure billed with it, because the procedure fee covers that visit. Check if the visit was separate.
• V30: OHIP doesn't pay this fee code with this diagnostic code. Check both codes against the chart and resubmit if one is wrong.
• V31: The claim header is missing the group number, billing number or specialty code. Fill in the header and resubmit.
• V34: The fee code can't be billed by this type of provider. Use a code your provider type can bill, or have the right provider bill it.
• V35: The claim doesn't qualify as an out-of-province or out-of-country service. Check the patient and payment program details.
• V36: The claim is missing details required for sessional billing. Check the sessional billing requirements and resubmit.
• V39: The claim has more than 99 items. Split it into smaller claims and resubmit.
• V4: OHIP refused a weekend or holiday code because the service date wasn't a Saturday, Sunday or holiday. Check the date, then bill the weekday code.
• V40: The fee code is missing or in the wrong format. It must be a letter, three digits and a suffix A, B or C.
• V41: V41 means the fee submitted on the claim is missing or invalid. Since May 2026 it is also used for FHO hourly codes billed at $0.00.
• V42: V42 means the number of services on the claim is missing or invalid. It must be two digits from 01 to 99.
• V47: The fee billed doesn't divide evenly by the number of services. Correct the fee or the number of services and resubmit.
• V5: V5 means the patient already had an insured major eye exam within the allowed period, from any physician or optometrist, so this one wasn't paid.
• V50: The physiotherapy service date is before the patient's initial visit. Check the dates and resubmit.
• V51: The location code must be blank or four digits from the Ministry's residency code list. Correct it and resubmit.
• V53: The fee code isn't valid for this method of submission. Check the code and resubmit.
• V6: An initial assessment was already paid for this patient, so this one was paid at the minor assessment fee instead.
• V62: The service location indicator (SLI) for this hospital diagnostic service isn't one of the five valid codes. Correct it and resubmit.
• V63: The referring laboratory number must start with 5 (5###). Correct it and resubmit.
• V64: The claim needs a service location indicator (SLI) and had none. Add the correct SLI and resubmit.
• V65: A hospital SLI (HDS, HED, HIP, HOP or HRP) was used without a master number. Add the hospital's master number and resubmit.
• V66: V66 means a hospital diagnostic claim used SLI code HIP but had no admission date. Add the patient's admission date and resubmit.
• V67: V67 means a hospital diagnostic claim used SLI code HIP but had neither a master number nor an admission date. Add both and resubmit.
• V68: V68 means a diagnostic claim had a master number and admission date but its SLI was not HIP. Fix the SLI, or remove the admission date, and resubmit.
• V69: V69 means the service location indicator on the claim isn't valid for that service date. Check the date and use an SLI that applies on that date.
• V7: OHIP paid this assessment at the medical/specific re-assessment fee because the limit for full specific assessments was reached. Usually no action.
• V70: V70 means the service date is later than the date the claim file was created. Correct the date, or wait until the service has been provided.
• V71: V71 means the dental master number on the claim isn't valid. Check the facility's master number and resubmit.
• V73: V73 means the claim used the OTN service location indicator, which ended for services from Dec 1, 2022. Remove OTN and bill under virtual care rules.
• V8: OHIP paid this service at a lower fee under one of its payment policies. Find which rule applied before deciding on an RAI.
• V9: OHIP limits this initial office visit to one per 12 months for the patient. The line was refused or reduced. Check for an earlier initial visit.
• V98: V98 means the service date on a preventive care claim is wrong. Check the date rules for that preventive care code and resubmit.
• VA: OHIP reduced the procedure fee because a consultation or visit was paid with it and the two can't both be paid in full. Check the pairing.
• VB: Code VB is about the extra eye exam (OVA) allowed once in the second year for patients aged 20 to 64 after a periodic OVA. Check the exam limits.
• VC: A procedure already paid can't be paid in addition to this visit, so OHIP paid the visit only for the difference. Usually no action.
• VG: OHIP allows only one geriatric general assessment premium per patient per 12 months. The premium on this line was refused.
• VH0: VH0 means a claim had an Ontario health number and also a Claim Header 2 (used for out-of-province patients). Keep only the one that fits and resubmit.
• VH1: VH1 means the claim's health number is blank or isn't a valid Ontario health number. Check the 10 digits and resubmit.
• VH2: VH2 means the claim had no health number but the payment program was HCP or WCB, which need one. Add the patient's health number and resubmit.
• VH3: VH3 means the claim's payment program was missing or not HCP, RMB or WCB. Set the right payment program and resubmit.
• VH4: VH4 means the version code on the claim isn't valid. Get the version code from the patient's current card and resubmit.
• VH5: VH5 means OHIP needs an OHIP number, not a health number, for this service date. Check the date and patient identifier and resubmit.
• VH6: VH6 means the service dates on the claim are mixed in a way OHIP won't accept. Check each date and split the claim if needed.
• VH7: VH7 means the claim carried both a health number and an OHIP number. Keep only the identifier that applies and resubmit.
• VH8: VH8 means the patient's date of birth on the claim doesn't match OHIP's record for that health number. Correct the date of birth and resubmit.
• VH9: VH9 means the health number on the claim isn't registered with the Ministry. Check it against the patient's card and resubmit.
• VHA: VHA means the OHIP number on the claim isn't registered with the Ministry for that health number. Check the patient's identifiers and resubmit.
• VHB: VHB means a health number was sent with a fee code that doesn't take one (a non-encounter service). Remove the health number and resubmit.
• VHC: VHC means a technical fee was billed without a service location indicator (SLI). Add the SLI for where the service was done and resubmit.
• VHO: VHO is the same rejection as VH0: an Ontario health number and a Claim Header 2 on one claim. Keep only the one that fits and resubmit.
• VJ5: VJ5 means the service date is missing, badly formatted, impossible, or later than the Ministry's run date. Enter a valid date and resubmit.
• VJ7: VJ7 means OHIP received the claim more than three months after the service date, so it was rejected as stale-dated.
• VJ8: VJ8 means a stale-dated claim: it reached OHIP more than three months after the service. Use the stale-dated process if it was first sent on time.
• VM: Code VM means an oculo-visual minor assessment is only paid within the eligibility period after a major eye exam. Check the earlier exam date.
• VN: OHIP paid this eye exam as a major oculo-visual examination for a senior with a medical condition. Informational; usually no action.
• VP: Code VP means this service is only paid with a special visit. Without a qualifying special visit premium, the line was refused.
• VR: Code VR means the visit premium claimed doesn't apply to this visit, so it was refused. Check the premium's conditions.
• VS: Code VS notes that the service date was a Saturday, Sunday or statutory holiday. Usually informational; check any weekend premium paid.
• VS1: VS1 means the SEAMO provider code on a SEAMO claim isn't valid. Correct it with the value your SEAMO setup expects and resubmit.
• VS2: VS2 means the venue type on a SEAMO claim isn't valid. Correct it with the value your SEAMO setup expects and resubmit.
• VS3: VS3 means the clinic number on a SEAMO claim isn't valid. Correct it with the value your SEAMO setup expects and resubmit.
• VS4: VS4 means the healthcare item on a SEAMO claim isn't valid. Correct it with an item your SEAMO setup accepts and resubmit.
• VS5: VS5 means the in-patient/out-patient indicator on a SEAMO claim isn't valid. Correct it with the value your SEAMO setup expects and resubmit.
• VS6: VS6 means the healthcare item code on a SEAMO claim is in the wrong format. Correct the code format and resubmit.
• VT1: VT1 means more than one virtual modality indicator (K300A or K301A) was sent for the same service. Keep one and resubmit.
• VTC: VTC means a virtual care claim was sent without a modality indicator (K300A video or K301A phone). Add one and resubmit.
• VW1: VW1 means the service isn't valid for the WCB (WSIB) payment program. Check the fee code, or bill it to OHIP if it isn't work-related.
• VX: Code VX means a complexity premium was claimed with a visit fee it doesn't apply to, so the premium was refused.
• W3: W3 is a warning that the service date is more than three months old. Check how the claim was paid and the three-month submission rule.
• W4: W4 is a warning that the claim had no service location indicator (SLI). Add the SLI on future claims where one applies.
• X2: OHIP didn't pay the cine/videotape study separately because the GI tract exam includes it. Usually no action.
• X3: OHIP didn't pay the abdominal survey film separately because the GI tract exam includes it. Usually no action.
• X4: OHIP refused this bone density (BMD) test because one was already paid in the last 36 months. Check the patient's BMD history.
• X5: OHIP refused this bone density (BMD) test because one was already paid in the last 12 months. Check the patient's BMD history.
• X6: OHIP refused this bone density (BMD) test because one was already paid in the last 60 months for a lower-risk patient. Check BMD history.

All OHIP error, rejection and explanatory codes