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Error code

DM — Paid/denied per MOH Emergency Department Equivalent policy

Walk-in weekend rules applied

OHIP applied its emergency department equivalent rules for walk-in or urgent care clinics, so this line was paid differently or not at all.

What to do: If an assessment was billed beside A888A, keep A888A and remove the other assessment.

Code
DM
Description
Paid/denied per MOH Emergency Department Equivalent policy

Explanation

Updated October 26, 2026

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.

What it means

DM means the line was paid or disallowed under the Ministry's policy for an emergency department equivalent. The Schedule of Benefits defines that as an office or other place, such as an urgent care centre, walk-in clinic or extended hours clinic (not a hospital emergency department), where the only insured services are for patients without pre-arranged appointments (GP3).

In that setting, an assessment on a Saturday, Sunday or holiday to deal with an emergency is billed as A888A, the emergency department equivalent partial assessment ($44.55, A5). For that service A888 is the only fee code payable, and no premiums are payable for a service in an emergency department equivalent (A5). Special visit premiums are never payable with A888 (GP3).

A888 uses its own holiday list, which counts every day from December 25 to 31 (GP3). The OMA's guide notes that procedures done at the visit can still be billed with A888, and that the primary care after-hours code (Q012A, or Q016A for CCM) can be billed with A888 for enrolled patients.

Common causes

  • Another assessment code, such as A007A, billed with A888A for the same visit
  • A premium (for example a special visit premium, E409, or G700A) billed for a service in a walk-in or urgent care setting
  • A888A billed on a weekday that isn't on A888's holiday list
  • For FHO physicians, the weekend access code Q888A billed together with an assessment code

How to fix it

  1. Check which line carries DM and what else was billed for the visit.
  2. If an assessment was billed beside A888A (or Q888A), the visit is one assessment. Keep A888A and remove the other assessment, or bill the assessment alone if the clinic wasn't operating as an emergency department equivalent.
  3. Remove premiums that aren't payable in an emergency department equivalent. Procedures and, for enrolled patients, the after-hours Q code can stay.
  4. For a $0 line, resubmit the corrected claim within three months of the service date. If that window has passed but the claim was first submitted on time, use the stale-dated process, or send a Remittance Advice Inquiry (RAI) within 7 months of the RA date.
  5. If you believe the setting wasn't an emergency department equivalent (for example, the clinic also saw booked patients), send an RAI explaining the setting.

Don't resubmit if

  • The DM line is a premium or second assessment that can't be paid in this setting. Resending it will be refused again.
  • Part of the visit was paid and you only want the refused premium. There is nothing more to claim.

How APEX handles it

APEX lists DM claims in the Correction Centre. For some family practice claims it drafts a corrected claim: check the drafted codes against the chart before you approve it. If you've turned on auto-fix, drafted corrections are sent without waiting for you. Other DM claims are listed under Outstanding for your input. See how APEX works · Pricing

Related codes: IA, I6, B8, V4

Sources