How do I fix OHIP error code P5?

Check the patient's date of birth against the health card and the claim. Check the age range of the code you billed. If the date of birth was wrong, correct it in the chart. If the claim is on the RA, send an RAI with the correct information. Send it through eSubmit, or on form 0918-84, within 7 months of the RA date. If the patient was over the age limit, bill future visits with the codes that fit the patient's age.

When shouldn't I resubmit a P5 claim?

The patient really was over the age limit on the service date. The claim is already on your Remittance Advice. Use an RAI, not a new claim.

< Error codes

Error code

P5 — Patient too old for pediatric rates

Q: What does OHIP error code P5 mean?

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.

Patient over age limit

OHIP's records show the patient was too old for the paediatric rate claimed on the service date.

What to do: Check the patient's date of birth against the health card and the age range of the code billed.

Code: P5
Description: Patient too old for pediatric rates

Explanation

Updated October 26, 2026

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.

What it means

Code P5 means OHIP's records show the patient was too old for the paediatric rate of payment claimed, so the line was reduced or refused.

The Ministry's description does not say which rates are involved. One age rule in the Schedule: a paediatrician's services for an adult are payable only if the paediatrician saw the patient in the 12 months before their 18th birthday, ongoing management of a chronic condition is needed, and the patient is under 22. The alternative is written prior approval from the Ministry (A168).

Common causes

The date of birth on the claim or on the Ministry's record is wrong
A paediatrician billed for a patient aged 18 or older who doesn't meet the A168 conditions
A code meant for a younger age group was billed for an older patient

How to fix it

Check the patient's date of birth against the health card and the claim.
Check the age range of the code you billed.
If the date of birth was wrong, correct it in the chart. If the claim is on the RA, send an RAI with the correct information. Send it through eSubmit, or on form 0918-84, within 7 months of the RA date.
If the patient was over the age limit, bill future visits with the codes that fit the patient's age.

Don't resubmit if

The patient really was over the age limit on the service date.
The claim is already on your Remittance Advice. Use 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: P6, A2A