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Error code

J5 — Coverage applied for; premiums not yet paid

Coverage applied for

The patient applied for coverage, but it wasn't yet in effect on the service date.

What to do: Run a health card validation check and advise the patient to contact ServiceOntario.

Code
J5
Description
Coverage applied for; premiums not yet paid

Explanation

Updated October 26, 2026

J5 means the patient applied for coverage but the Ministry shows premiums as not yet paid. Advise the patient to contact ServiceOntario.

What it means

J5 reads "Coverage Applied For; Premiums Not Yet Paid". The Ministry's records show the patient's coverage was applied for but not yet in effect on the service date.

The message dates from when OHIP coverage had premiums. It is rarely seen today.

How to fix it

  1. Check the health number and service date on the claim.
  2. Run a health card validation check to see the patient's coverage status.
  3. Advise the patient to contact ServiceOntario about their coverage.
  4. If you believe the decision is wrong, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date, with supporting details.

Don't resubmit if

  • A validation check shows no coverage on the service date.
  • The line is already on your RA. Question it with an RAI, not a new claim.

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: J1, J8, EH1

Sources