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Error code

60 — Not covered under the Reciprocal Medical Billing Agreement

Not covered for out-of-province patient

The service isn't a benefit under the Reciprocal Medical Billing agreement for patients from another province, so OHIP didn't pay it.

What to do: Check whether the service is excluded from reciprocal billing; if so, contact the patient's home province plan.

Code
60
Description
Not covered under the Reciprocal Medical Billing Agreement

Explanation

Updated October 26, 2026

The service isn't covered under the Reciprocal Medical Billing agreement for out-of-province patients, so OHIP didn't pay it.

What it means

Code 60 means the service is not a benefit under the Reciprocal Medical Billing (RMB) agreement. RMB lets Ontario physicians bill OHIP for insured services to patients covered by another province's health plan.

Some services are excluded from reciprocal billing. When a service is excluded, OHIP doesn't pay it on the patient's behalf. The Error Report has a matching rejection, R04 (service excluded from RMBS).

How to fix it

  1. Check that the patient is from another province and the claim was billed as an RMB claim.
  2. Check whether the service is excluded from reciprocal billing.
  3. If it is excluded, the service can't be paid through OHIP. Contact the patient's home province plan about how to bill it.
  4. If you believe it is covered, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date.

Don't resubmit if

  • The service is excluded from reciprocal billing. Sending it again through OHIP won't be paid.

How APEX handles it

APEX reads your error reports and remittance advice from MCEDT and lists claims rejected with this code in its Correction Centre for you to correct and resubmit. See how APEX works · Pricing

Related codes: R04, R05, RD

Sources