< Error codes

Error code

MM — Claim does not meet Schedule of Benefits requirements

Code requirements not met

The claim doesn't meet the Schedule of Benefits requirements for the fee code billed, such as time, setting, records or diagnosis.

What to do: Read the code's full listing and payment rules, then check your record against each requirement.

Code
MM
Description
Claim does not meet Schedule of Benefits requirements

Explanation

Updated October 26, 2026

MM means the claim doesn't meet the Schedule of Benefits requirements for that fee code. Check the code's requirements and your records.

What it means

MM means OHIP found the claim does not meet the requirements of the Schedule of Benefits for the fee code billed.

Many codes have conditions: who may bill, where, the minimum time, records such as start and stop times, or the diagnosis. If a required element is missing, the service is not eligible for payment.

Common causes

  • A required element of the service was not done or not recorded
  • Time-based service without start and stop times in the chart (Schedule GP7)
  • A code billed by a physician, specialty or setting it isn't listed for

How to fix it

  1. Read the full listing and payment rules for the fee code in the Schedule of Benefits.
  2. Check your record against each requirement.
  3. If a different code fits what you did, ask the Ministry through an RAI.
  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

  • The record doesn't show the code's required elements.
  • 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: MR, 41, 50

Sources