OHIP Error Codes - Resubmit Your Claim & Get Paid - MDBilling.ca

OHIP Error Codes

A key part of medical billing in Ontario is reconciling your OHIP claims. Even the best billing agents experience the occasional error code and rejected claims. It’s frustrating but necessary to ensure payments are fair and accurate.

To help make things easier, we’ve compiled the most common OHIP error codes. You can find the error code using our unprocessed claims report. Each page below has a full explanation of the error and how to fix it. In most cases, you will need to resubmit the claim or complete an RA inquiry.

We’ve grouped the errors into buckets to make it easier to find what may be causing the issue with your claim. Click on the link to jump to the most appropriate section.

Patient Errors

A2A – Patient is underage or overage for this service code

EH1 – Service date is greater than eligibility end date

EH2 – Invalid version code

EH4/EH5 – OHIP Number Not Valid on the Date of Service

EH6 – Patient deceased

EP3 – Check Service Date / Enrolment Date

EPF – Enrollment Date Mismatch

HCC – Not on Health Care Connect (HCC) database

HCE – HCE Enrolment After 3 months

VH1 / VH4 / VH9 – OHIP number not valid

VH2 – HN is Missing

VH8 – No match on DOB with HN

Service Errors

A2B – This service is not normally performed for this sex

A3F – No fee exists for this service code on this date of service

A34 – Duplicate service codes submitted

A36 – Claimed by Other Practitioner

A3E – No such service code for date of service

A3H – Max Number of ser FSM ref MC

AC1 – Maximum Reached

AD1/AD9 – Corresponding procedure not claimed/Premium not allowed alone

AD5 – Service code only allowed once per patient per day

ADF – Corresponding procedure invalid, omitted or paid at zero

AMR – Minimum service requirements have not been met

AO3 – Claimed by Other Practitioner

ASP – Not allowed with surgical procedure

CNA – Counselling not allowed

DF – Corresponding procedure invalid, omitted, or is paid at zero

AH9 – Diagnostic/miscellaneous service for hospital patient is not allowed on a fee-for-service basis – included in the hospital global budget

V23 – Check no. of services

V35 – Invalid OOP/OOC Service

V39 – Number of items exceeds the maximum (99)

VW1 – Invalid WCB Service

Referral Errors

AC4 / ARF – Invalid Referral Number

ENP – Invalid service code for Nurse Practitioner referrals

R08 – Invalid referral number

ERF / EQ6 – Inactive or invalid referring physician

V09 – Invalid referral number

Provider Billing Number / Group Number Errors

EG1 – Group not Eligible

EQ1- Health care provider is not registered

EQB – Inactive provider billing number

EQC – Group number is not registered

EQD – Group number is not registered

EQE – Healthcare provider not registered as an affiliate of the group

EQF – Healthcare provider is not ACTIVELY registered with the Ministry as an affiliate of this Group on date of service

ESD – APP Group Affiliation on Service Date

ESF – A non-encounter service claim submitted by a physician not eligible to bill FSC codes

Facility Number (Location) / Admission Date Errors

AH5 – Invalid hospital admission date

AH8 – Hospital and/or Admission Date is missing or invalid

V28 – Invalid Hospital Number

V64 – Missing Service Location Indicator (SLI)

V65 – Missing master number

V66 – Missing Admission Date

V67 – Missing master number and admission date

V68 – Incorrect Service Location Indicator

V69 – Service date invalid for SLI

Service Date Errors

V70 – Date of service is greater than the batch/file creation date

VJ7/VJ8 – Stale dated claim

Specialty Errors

EQ2 – Specialty code is inactive or not registered on date of service

V08 – Invalid specialty code

A4D – Invalid specialty for this service code

Virtual Care Service Errors

ET1 – Provider Not Registered for Virtual Care Program

ET4 – Virtual care program B-code missing or SLI code invalid

ET5 – Virtual care program SLI code missing

TM1 – Duplicate Virtual Care Claim for Same Patient

TM3 – Service Not Payable Under Virtual Care Program

TM4 – Non-Virtual Care Claim Already Paid for This Patient

TM5 – Virtual Care Claim Already Paid for This Patient

TM6 – Virtual Care Program Registration Not in Effect on Service Date

TM7 – Dental Services Not Payable Under Virtual Care Program

Reciprocal Medical Billing (RMB) Errors

R02/R03 – Reciprocal medical billing error

Diagnostic Code Errors

V16 – Unacceptable Diagnostic Code

V21 – Diagnostic Code Required

V22 – Invalid diagnostic code

V30 – FSC / DX code Combination NAB

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