Error code
V1 — Initial assessment already billed - paid as repeat assessment
Paid as re-assessment
An initial assessment was already paid for this patient within the limit, so this one was paid at the lower repeat assessment fee.
What to do: Check the patient's history for an earlier initial assessment; bill follow-ups with the re-assessment code, such as A004.
- Code
- V1
- Description
- Initial assessment already billed - paid as repeat assessment
Explanation
Updated October 26, 2026
An initial assessment was already paid within the limit for this patient, so this one was paid at the lower repeat (re-assessment) fee.
What it means
The Ministry's wording for V1 is "Allowed as repeat assessment-initial assessment previously claimed". OHIP found an earlier initial-level assessment for the same patient and paid this claim at the repeat assessment rate.
Initial-level assessments have limits. For example, a general assessment (A003) is limited to one per patient per physician per 12 months, or two if the second is for a clearly different diagnosis or a hospital admission at least 90 days after the last one; services over the limit are paid at a lesser fee (GP21–GP25). Specific assessments by specialists have similar limits.
Common causes
- A general or specific assessment was billed again within 12 months for the same patient and diagnosis
- The second assessment was for a different problem, but the claim did not make that clear
- The first assessment was billed under a different service date than you expected
How to fix it
- Check the patient's claim history for an earlier initial assessment in the past 12 months.
- If there was one, the lower payment is expected. Bill the re-assessment code (for example A004) for follow-up visits.
- If the visit qualified as a second initial assessment (clearly different diagnosis, or a hospital admission at least 90 days after the last one), keep the chart notes that show this.
- If you believe the payment 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 claim is already on the RA. Use an RAI, not a new claim, if you disagree with the payment.
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