OHIP error codes that usually don’t need correcting
Seeing an unfamiliar code on your remittance can make it feel as though a claim went wrong. Some errors do need a correction, such as an incorrect health number or version code. The codes below are different.
I2, B2, C2, 30, 35, 36, 55, and 57 usually mean OHIP has already processed the claim, adjusted the amount, or linked it to an earlier claim. Sending the same claim again will not change the result and may create another rejection.
Here is what each code means and what you should check.
I2 — The visit is funded another way
OHIP describes I2 as "Service is globally funded." In most cases, this appears when a Family Health Organization (FHO) physician sees a patient on their roster.
Because the patient is already covered through capitation, OHIP pays the applicable shadow-billing amount instead of the full fee-for-service amount. The claim still appears on your remittance, but the lower payment is expected.
What to do: confirm that the patient was rostered and that the shadow-billing payment is correct. If both are correct, there is nothing to resubmit.
B2 and 30 — The virtual visit was processed
B2 and 30 normally appear together on virtual-care claims, including K300A video visits and K301A telephone visits. Seeing these codes does not mean the claim was rejected or underpaid.
For K301A telephone visits, OHIP pays 85% of the equivalent in-person fee. The remaining 15% is not payable. K300A is for video visits and pays 100% of the equivalent in-person fee.
What to do: look at the amount paid, not the B2 and 30 codes. As a rule of thumb, a K301A telephone visit should pay 85% and a K300A video visit should pay 100% of the equivalent in-person fee. If the paid amount is correct, the claim is fine and does not need to be resubmitted.
C2 — OHIP adjusted the claim to the allowed fee
C2 means "Allowed at re-assessment fee." OHIP received the claim at one amount and changed it to the fee allowed for that service.
For example, if A004A was submitted at $80.00, OHIP may pay the allowed $39.35 and add C2. If K033A was submitted at $80.00, OHIP may pay the allowed $56.30.
What to do: compare the amount paid with the current allowed fee. If they match, OHIP has already corrected the price and there is nothing to resubmit.
35 — OHIP has already received this claim
Code 35 means OHIP has a previous claim for the same patient, service, and date. This often happens when the same visit is submitted twice.
What to do: check your billing history for the original claim. If it was already submitted and processed, do not send it again.
36 — Another physician, group, or lab billed the service
Code 36 means OHIP has already received a claim for this patient and date from another physician, group, or laboratory.
What to do: check whether another provider legitimately billed the service. If the earlier claim is expected, there is nothing to resubmit. If it is unexpected, investigate the other claim before making any changes.
55 and 57 — OHIP adjusted an earlier claim
Code 55 is a deduction from an earlier claim. Code 57 is an additional payment on an earlier claim. These are adjustments, not new errors.
A common example is a patient who left a physician's roster. Visits that previously received I2 shadow-billing treatment may later be adjusted to full fee-for-service payment. Codes 55 and 57 show that correction.
What to do: trace the adjustment back to the original claim and confirm that the deduction or payment makes sense. Do not submit the adjustment as a new claim.
The goal is not to ignore these lines. It is to confirm that OHIP handled them correctly, then spend your time on claims where a change can actually recover payment. APEX keeps these codes out of the correction queue for that reason.
APEX offers every physician or group a unique, transparent overview over their billing records.