How to read your OHIP remittance advice
Your monthly Remittance Advice (RA) is the Ministry of Health's line-by-line statement of what OHIP approved and paid. This guide walks through each part on an annotated sample and shows what to do when a payment doesn't match what you billed.
When the RA arrives
- 5th–7th RA reaches your mailbox
- 15th payment on or before
- 18th cut-off for next month's RA
The RA arrives in your MCEDT mailbox, with your Error Reports, before the money does (Resource Manual). A claim sent on September 10 will usually appear on the October RA.
Cut-off rules and the RA file
Each RA covers the claims the Ministry approved in its previous monthly processing cycle. Claims received by the 18th of the month are typically processed for approval the following month. If the 18th falls on a weekend or holiday, the deadline moves to the next business day. Our OHIP billing submission cut-off dates schedule lists the dates.
The RA is a data file, not a printed statement. Your billing software turns it into a readable report, so column names and their order differ from one program to another. The parts described below are the ones defined in the Ministry's file layout.
What's on an RA
| Part | What it shows |
|---|---|
| Header | Six-digit billing number, four-character group number (if you bill as a group), specialty, payment date, payee name, total amount payable |
| Address | Your address on file with the Ministry, or your billing agent's |
| Claims | A header line per claim, then one or more item lines |
| Balance forward | Only if last month's remittance was negative |
| Accounting transactions | Amounts not tied to a single claim |
| Messages | Ministry notices to all or selected physicians |
| Total amount payable | Paid claim lines, plus or minus accounting transactions and any balance forward |
The total amount payable should match your deposit. Ontario patients' names aren't shown, so match lines by accounting number and health number.
Claim lines
| Line | Fields |
|---|---|
| Claim header | Ministry claim number · original claim or adjustment to an earlier one · your accounting number · health number and version code · payment program |
| Item | Service date · number of services · fee code · amount submitted · amount paid · explanatory code (if any) |
Accounting transaction codes
| Code | Meaning |
|---|---|
| 10 | Recovery of an advance |
| 20 | Reduction |
| 40 | Payment: capitation, premium, administration, summary and special payments |
| 50 | Estimated payment for claims sent before the cut-off but not fully processed |
More on each part of the RA
Header: the first record names the payee. The payment date is the cheque or direct deposit date, and the payee name is as registered with the Ministry. When you are paid by direct deposit, the cheque number field is filled with 9s.
Address: two address records follow. They show your address as registered with the Ministry, or your billing agent's name and address if one is registered for you.
Patient names: the RA does not show patient names for Ontario patients. The name fields are filled only for claims for patients from other provinces (Reciprocal Medical Billing, or RMB). Those claims are listed at the end of the file, after all other claims. To match a line to a patient, use the accounting number your software assigned and the health number.
Balance forward: it shows the amount carried into this month, split into claim adjustments, advances and reductions.
Accounting transactions: each transaction has a date, an amount and a short description.
Messages: the Ministry uses the RA's message facility to send notices to all physicians or to selected ones. Read them and keep a copy. They often announce fee changes or claim reprocessing that explains lines you would otherwise question.
Total amount payable: the sum of the amounts paid on every claim line, plus or minus the accounting transactions and any balance forward.
Group, Family Health Network and enrolment-model reports
If you are in a group, the group RA lists claims by physician within the group. Physicians in a Family Health Network can also get an RA Split/Extract that contains only their own claims.
Physicians in patient enrolment models get separate monthly reports through MCEDT that break down the model payments. These include the OHIP Payment Summary Report and the Roster and Capitation Payment Reconciliation Report. They sit alongside the RA, not inside it.
An annotated sample
This sample is made up: the billing number, health numbers and amounts are fictional, and a real RA would have many more lines. Fees are from the Schedule of Benefits effective July 1, 2026.
Header and parts not tied to a claim
| # | Part of the RA | Sample entry |
|---|---|---|
| 1 | Billing number | 012345 (solo, no group number) · specialty 00 |
| 2 | Payment date | 2026/10/15 |
| 3 | Payee and address | SAMPLE, DR A · 100 EXAMPLE ST, TORONTO ON |
| 4 | Total amount payable | $1,507.90 · cheque number 99999999 (direct deposit) |
| 5 | Accounting transaction | Code 40 (payment) · 2026/10/01 · +$1,250.00 · description from the Ministry |
| 6 | Balance forward | Not present this month |
| 7 | Messages | Ministry notices, if any |
Claim lines
| # | Health number | Accounting no. | Service date | Fee code | No. of services | Submitted | Paid | Explan. code |
|---|---|---|---|---|---|---|---|---|
| 8 | 1234 567 890 | 00010231 | 2026/08/24 | A007A | 1 | $44.55 | $44.55 | |
| 9 | 2345 678 901 | 00010232 | 2026/08/27 | A007A | 1 | $44.55 | $44.55 | |
| 10 | 2345 678 901 | 00010232 | 2026/08/27 | G590A | 1 | $8.80 | $8.80 | |
| 11 | 3456 789 012 | 00010240 | 2026/08/29 | A007A | 1 | $44.55 | $0.00 | 35 |
| 12 | 4567 890 123 | 00010245 | 2026/09/02 | K013A | 2 | $160.00 | $160.00 | |
| 13 | 5678 901 234 | 00009877 | 2026/06/12 | A007A | 1 | $44.55 | -$44.55 | 55 |
| 14 | 5678 901 234 | 00009877 | 2026/06/12 | A007A | 1 | $44.55 | $44.55 | 57 |
Read it in this order
- Billing number (row 1). Solo billing number 012345, specialty 00 (family practice). On a group RA, the group number appears here and claims are listed physician by physician.
- Payment date (row 2). The date of the cheque or direct deposit, not the date the RA reached your mailbox.
- Payee and address (row 3). Taken from the Ministry's registration records. An out-of-date address has to be changed with the Ministry.
- Total amount payable (row 4). $257.90 from the claim lines plus the $1,250.00 accounting transaction. Compare it with your bank deposit. The 9s in the cheque number mean direct deposit.
- Accounting transaction (row 5). Code 40 is a payment not tied to one claim, such as a capitation, premium or special payment. The description says which. In an enrolment model, check it against your Payment Summary and Roster and Capitation reports.
- Balance forward (row 6). Nothing carried over, because last month's remittance wasn't negative. Had OHIP recovered more than it paid you last month, the shortfall would show here and be taken from this month's total.
- Messages (row 7). Ministry notices print at the end of the RA. A notice about reprocessed claims often explains adjustment lines like rows 13 and 14.
- Paid as billed (row 8). Paid matches submitted and there is no explanatory code. Accounting number 00010231 is the number your software gave the claim, so tick it off in your records.
- One claim, two items (rows 9–10). Same accounting number and health number. Each item is paid separately and could carry its own code.
- A duplicate (row 11). Code 35: OHIP's records show this service was already claimed, so the line paid $0.00. Look for the original claim before doing anything. See code 35.
- More than one service (row 12). The number of services is 2, so the amount submitted is twice the unit fee. Check it matches what you billed.
- An adjustment pair (rows 13–14). Row 13 (code 55) takes back the earlier payment for a June visit; row 14 (code 57) pays it again. They cancel out, so nothing changed. See code 55 and code 57.
When an adjustment pair doesn't cancel out
A 55 and 57 pair usually happens when the Ministry reprocesses claims. If the 57 line had been smaller, or missing, OHIP would have lowered what it paid for that visit.
How to reconcile your RA
- Match every RA line to a claim you sent, using the accounting number, health number, service date and fee code.
- List the claims you sent that are not on the RA. Check your Error Reports for them first.
- Allow for the cut-off. A claim received after the 18th is usually on the following month's RA, not this one.
- Compare paid with submitted on each line. Read the explanatory code on every line that differs.
- Pair each 55 line with its 57 line and look at the net change, not the two lines separately.
- Check the accounting transactions and any balance forward, then confirm the total amount payable matches your deposit.
- Keep every RA. You have 7 months from the RA date to question a payment on it.
What the explanatory codes mean
| RA explanatory code | Error Report code | |
|---|---|---|
| Length | Two characters | Three characters (for example VJ7) |
| Claim status | Processed | Rejected, not processed for payment |
An RA code explains why the payment differs from what you billed, or flags something about the claim.
Many codes need no action. A few common examples:
| Code | Meaning | What to do |
|---|---|---|
| 30 | Service is not a benefit of OHIP | Expected on $0 tracking codes. On a service you expected to be paid for, look closer |
| 35 | OHIP records show the service was already claimed | Usually a true duplicate |
| 55 and 57 | A deduction and a payment that adjust an earlier claim | Check the net amount |
| I2 | Service is globally funded | Expected: in a capitation model, an in-basket service for an enrolled patient is shadow billed rather than paid at the full fee |
| 48 | Paid as submitted, but clinical records may be requested for verification | Tells you how the line was paid |
| 50 | Paid in accordance with the Schedule of Benefits | Tells you how the line was paid |
| 51 | Fee code changed in accordance with the Schedule | Tells you how the line was paid |
Our list of OHIP error and explanatory codes explains each code and what to do about it.
When OHIP paid less, or nothing
| Where the claim shows | What happened | What to do |
|---|---|---|
| Error Report, not the RA | Rejected, not in the payment stream | Correct it and resubmit, within 3 months of the service date if you can |
| RA, paid less or $0 | Processed | Send a Remittance Advice Inquiry (RAI) within 7 months of the RA date. Don't resubmit |
| Neither report | Never received, or the batch was rejected | Check the Batch Edit Report, fix the problem and send it again |
Don't send a paid-less claim again. The OMA notes that a resubmitted claim will simply be rejected and the issue left unresolved (OMA guide).
Sending an RAI
- Confirm you disagree with the result and the RA date is within the last 7 months.
- Gather information or documents that support your request.
- Submit through eSubmit (on the GO Secure website, or as an eSubmit upload through MCEDT), or on form 0918-84 by mail or by fax to 1-905-434-4186.
Claims past the 3-month window
If the 3-month window has passed but the claim was first sent on time, use the Ministry's stale-dated process (INFOBulletin 230402). See VJ7: stale-dated claim and our guide to stale-dated OHIP claims and RAIs.
A claim sent more than 3 months after the service date will reject with VJ7.
Sources
Resource Manual for Physicians: Claims submission (Ministry of Health)
Remittance Advice Explanatory Codes/Messages (Ministry of Health, March 2026)
Technical Specification for Reports sent via MCEDT (Ministry of Health)
INFOBulletin 230402: Update, claim submission timeframe for in-province accounts
eSubmit: ready, set, GO Secure (Ministry of Health)
Remittance Advice Inquiry form 0918-84 (Central Forms Repository)
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