How do I fix OHIP error code R1?

Find the date of the patient's last periodic health visit in your billing history and count 12 months from it. If the visit was a routine check-up within 12 months of the last one, OHIP won't pay it and there's nothing to resubmit. If the patient came in with a medical problem that you assessed, bill the assessment that matches what you did, for example A007 intermediate assessment ($44.55, A4), with the diagnostic code for that problem. If you believe the last exam was more than 12 months earlier, or was billed by another physician (the Schedule's limit is per physician), send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date. Book future yearly exams at least 12 months after the last one.

When shouldn't I resubmit a R1 claim?

The visit was a routine exam less than 12 months after the last one. You'd be billing a different code only to get paid. The code must describe the service you gave. You want to dispute the 12-month count. Use an RAI.

< Error codes

Error code

R1 — Only 1 health exam allowed within 12 months

Q: What does OHIP error code R1 mean?

R1 means OHIP already has a health exam for this patient in the past 12 months, so this periodic health visit wasn't paid.

Health exam already paid

OHIP already paid a periodic health visit for this patient in the past 12 months, so this one wasn't paid.

What to do: Count 12 months from the last periodic health visit; a routine check-up within that time isn't payable.

Code: R1
Description: Only 1 health exam allowed within 12 months

Explanation

Updated October 26, 2026

R1 means OHIP already has a health exam for this patient in the past 12 months, so this periodic health visit wasn't paid.

What it means

R1 is a remittance advice explanatory code, not an Error Report rejection. The Ministry's wording is 'Only one health exam allowed in a twelve-month period'.

Family physicians bill health exams as periodic health visits: K017 child ($49.55), K130 adolescent ($87.10), K131 adult 18 to 64 ($64.25), K132 adult 65 and older ($91.35) and K133 adult with an intellectual or developmental disability ($164.25). Paediatricians bill K267 and K269 (GP22, A4, A9).

The Schedule limits periodic health visits to one per patient per 12 months per physician, and visits over the limit are not insured (GP21). Only one of K131, K132 or K133 is payable per patient per physician in 12 months (A9). Well-baby visits and the well-child exam for ages 2 to 5 have their own codes, R2 and R3.

Common causes

A yearly physical booked a few days or weeks short of 12 months after the last one
A visit for a new problem billed as a periodic health visit
K133 billed within 12 months of a K131 or K132 for the same patient, or the other way round

How to fix it

Find the date of the patient's last periodic health visit in your billing history and count 12 months from it.
If the visit was a routine check-up within 12 months of the last one, OHIP won't pay it and there's nothing to resubmit.
If the patient came in with a medical problem that you assessed, bill the assessment that matches what you did, for example A007 intermediate assessment ($44.55, A4), with the diagnostic code for that problem.
If you believe the last exam was more than 12 months earlier, or was billed by another physician (the Schedule's limit is per physician), send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date.
Book future yearly exams at least 12 months after the last one.

Don't resubmit if

The visit was a routine exam less than 12 months after the last one.
You'd be billing a different code only to get paid. The code must describe the service you gave.
You want to dispute the 12-month count. Use an RAI.

How APEX handles it

APEX lists R1 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 R1 claims are listed under Outstanding for your input. See how APEX works · Pricing

Related codes: R2, R3, M1