OHIP rejection codes, explained.
An OHIP rejection code is the two- or three-character reason the Ontario Ministry of Health returns when it rejects or reduces a claim on your remittance advice (RA) or error report. This guide covers what each code means, what to check, and how to fix and resubmit. The codes you hit most often come first.
Start here
The most common OHIP rejection codes
A3E — No such service code for date of service
The service code isn't valid for that date of service. Check it against the Schedule of Benefits in effect on the service date. OHIPay prices codes as you enter them and flags one that has no active fee for the date.
A3F — No fee exists for this service code on this date of service
The fee schedule has no active fee for that code on that date of service. Verify the code and date against the current Schedule of Benefits. OHIPay prices every line against the fee schedule and raises a non-blocking A3F advisory when a code has no fee for the date.
A34 — Multiple duplicate claims
The Ministry received more than one claim for the same service. Check whether it was already submitted before you resubmit. OHIPay tracks each claim's submission status, so you can see what has already gone to the Ministry.
AC4 — Unaccepted Referral Number
The referring provider's billing number is missing or invalid on a service that requires a referral. Enter a valid 6-digit referring number. OHIPay's referring-physician directory autofills it and warns on consult claims with no referral.
AH8 — Invalid Admission Date and/or Hospital number.
The admission date and/or master hospital number on an inpatient claim is missing or invalid. Confirm the admission date and the facility. OHIPay derives the inpatient setting and carries the admission date and master number for in-hospital codes.
AMR — Minimum service requirements have not been met
The service didn't meet the Ministry's minimum requirements to be paid (for example time or component rules for that code). Review the service against the Schedule of Benefits requirements for the code before resubmitting.
ARF — Missing Physician Referring Number
A referral was required but no referring-physician billing number was supplied. Add the referring provider's number before you resubmit. OHIPay flags referral and consult claims that are missing it, and can look the number up from its referring-physician directory.
EH2 — Mismatched Version Code
The health card's 2-letter version code didn't match the Ministry's record on the service date. Re-validate the card (HCV), correct the version code, then resubmit. OHIPay flags this before you submit. Full guide →
EH4 — Service Date after Eligibility End Date
The service date falls after the patient's OHIP coverage ended. Re-check the health card (HCV) to confirm the service date and current eligibility before you resubmit. OHIPay's health-card validation surfaces coverage problems up front.
EH5 — Service Date Not in Eligibility Period
The patient wasn't eligible for OHIP on the service date. Run a health-card validation (HCV) to confirm active coverage for that date; OHIPay checks the card and flags eligibility gaps before submission.
EH6 — Eligibility Terminated - Deceased
The Ministry's records show the patient as deceased, so coverage has ended. Confirm the patient identity and the service date. A health-card validation (HCV) surfaces terminated eligibility before you submit.
VJ7 — Stale-dated Claim
The claim was submitted past the Ministry's stale-dating window. OHIPay warns you as the deadline approaches so claims don't age out before they're sent.
Reference
The complete OHIP rejection code list
Search the full list of OHIP error, MCEDT, and Remittance Advice codes. Descriptions are the Ministry of Health's own, reproduced under the Ontario Open Government Licence. Where a code has its own guide, the meaning links through to a full walkthrough.
| Code | Meaning | Category |
|---|---|---|
09 | Fee Schedule Code(s) used is not correct, please resubmit claim with the appropriate FSC or submit an RAI if the claim is posted on a Remittance Advice | Payment / Adjudication |
30 | Service is not a benefit of OHIP (Ontario Health Insurance Plan) | Payment / Adjudication |
31 | Not a valid network service | Payment / Adjudication |
32 | OHIP records show service(s) on this day claimed previously | Payment / Adjudication |
33 | Approved | Payment / Adjudication |
35 | OHIP records show this service rendered has been claimed previously (used on Pay Practitioner duplicate claims) | Payment / Adjudication |
36 | OHIP records show service has been rendered by another Practitioner, Group, Lab | Payment / Adjudication |
37 | Effective April 1, 1993 the listed benefit for this code is 0 Laboratory Medicine Services (LMS) units | Payment / Adjudication |
40 | Service or related service allowed only once for same patient | Payment / Adjudication |
41 | Fee Schedule Code (FSC) Billed - No Evidence in Supporting Documentation Provided | Payment / Adjudication |
42 | FSC Billed Included in Other Procedure | Payment / Adjudication |
45 | Specialty code restriction on Fee Schedule Code | Payment / Adjudication |
46 | Paid Per 2nd Review by Medical Advisor (MA) | Payment / Adjudication |
47 | Not Paid Per 2nd Review by Medical Advisor (MA) | Payment / Adjudication |
48 | Paid as submitted - clinical records may be requested for verification purposes | Payment / Adjudication |
49 | Paid according to the average fee for this service. Independent consideration will be given if clinical records/operative reports presented. | Payment / Adjudication |
50 | Paid in accordance with the Schedule of Benefits | Payment / Adjudication |
51 | Fee Schedule Code changed in accordance with Schedule of Benefits | Payment / Adjudication |
52 | Fee-for-service assessed by medical consultant | Payment / Adjudication |
53 | Fee allowed according to appropriate item in a previous Schedule of Benefits | Payment / Adjudication |
54 | Interim payment - claim under review | Payment / Adjudication |
55 | Deduction is an adjustment on an earlier account | Payment / Adjudication |
56 | Claim under review | Payment / Adjudication |
57 | This payment is an adjustment on an earlier account | Payment / Adjudication |
58 | Claimed by another physician within group | Payment / Adjudication |
59 | Practitioner's notification - WCB claims | Payment / Adjudication |
60 | Not a benefit of the Reciprocal Medical Billing Agreement | Payment / Adjudication |
62 | Claim assessed by Assessment Officer | Payment / Adjudication |
65 | Service included in approved hospital payment | Payment / Adjudication |
66 | Reduced per Alternative Payment Program (APP) Funding Contract | Payment / Adjudication |
69 | Elective Services Paid At 75% Of OHIP Schedule of Rates | Payment / Adjudication |
70 | OHIP records show corresponding procedure(s) on this day claimed previously by another physician | Payment / Adjudication |
80 | Technical fee adjustment for hospitals | Payment / Adjudication |
A1A | Outside Service Period | General |
A2A | Outside of Age Limit - Patient is underage or overage for this service code | General |
A2B | Wrong Sex for Service - This service is not normally performed for this sex. Please check your records. | General |
A34 | Multiple duplicate claims | General |
A36 | Claimed by Other Practitioner | General |
A3E | No such service code for date of service | General |
A3F | No fee exists for this service code on this date of service | General |
A3G | Fee Billed Low | General |
A3H | Maximum Number Services per the Fee Schedule Master (FSM) | General |
A3I | X-Ray Code - Maximum Number Services per the Fee Schedule Master (FSM) | General |
A3L | Other New Patient Fee Already Paid | General |
A4D | Invalid specialty for this service code | General |
AC1 | Maximum reached - resubmit alternate Fee Schedule Code (FSC) | General |
AC4 | Unaccepted Referral Number. Not 6 numerics; equal to the Practitioner billing number; referring number is 722900-744292 (Nurse Practitioner) and FSC is not eligible for NP referral; referring number is 700000-722899 (Midwife) and FSC is not eligible for MW referral. | General |
AD3 | Not allowed with visit | General |
AD5 | Procedure allowed previously | General |
AD8 | Not allowed alone | General |
AD9 | Premium not allowed alone | General |
ADF | Corresponding Procedure Invalid, Omitted or Paid at zero | General |
ADH | Cannot be billed together | General |
AH | Not allowed in addition to health exam | Payment / Adjudication |
AH8 | Invalid Admission Date and/or Hospital number. | General |
AHF | Concurrent or Supportive Care Same Period | General |
AM1 | Service Limit Exceeded | General |
AMR | Minimum service requirements have not been met | General |
AMS | Multiple Procedures | General |
AO2 | Previous Obstetrical Service | General |
AO3 | Most Responsible Physician (MRP) Visit Already Paid | General |
AP | This payment is in accordance with legislation. If you disagree with the payment, you may appeal to the General Manager | Payment / Adjudication |
ARF | Missing Physician Referring Number | General |
ARP | Referring Physician Number Required | General |
ASP | Not Allowed with Surgical Procedure | General |
AT1 | Only One Modality Allowed | General |
AT2 | Must Include Video Modality | General |
AT3 | No Patient-Physician Relationship | General |
AT4 | Modality Not Allowed | General |
B1 | Service Not Eligible for Payment When Delivered by Telephone | Virtual Care |
B2 | Paid in accordance with the OHIP Schedule of Benefits for Telephone Virtual Care Services | Virtual Care |
B3 | Patient-Physician Relationship Requirements Not Met | Virtual Care |
B4 | Virtual Service not allowed in addition to In-Person Equivalent Service | Virtual Care |
B5 | In-Person Service Not Allowed in Addition to Virtual Equivalent Service | Virtual Care |
B6 | Limited Virtual Care Service Already Paid | Virtual Care |
B7 | Comprehensive Virtual Care Service Already Paid | Virtual Care |
B8 | Service Not Eligible for Payment Virtually | Virtual Care |
C1 | Allowed as repeat/limited consultation/midwife-requested emergency assessment | Assessments / Consultations |
C2 | Allowed at re-assessment fee | Assessments / Consultations |
C3 | Allowed at minor assessment fee | Assessments / Consultations |
C4 | Consultation not allowed with this service - paid as assessment | Assessments / Consultations |
C5 | Allowed as multiple systems assessment | Assessments / Consultations |
C6 | Allowed as Type 2 admission assessment | Assessments / Consultations |
C7 | An admission assessment (C003A) or general re-assessment (C004A) may not be claimed by any physician within 30 days following a pre-dental/pre-operative assessment | Assessments / Consultations |
C8 | Payment reduced to geriatric consultation fee - maximum number of comprehensive geriatric consultations has been reached | Assessments / Consultations |
C9 | Allowed as in-patient interim admission orders - initial assessment already claimed by other physician | Assessments / Consultations |
CNA | Counselling Not Allowed | General |
D1 | Allowed as repeat procedure - initial procedure previously claimed | Procedures |
D2 | Additional procedures allowed at 50% | Procedures |
D3 | Not allowed in addition to visit fee | Procedures |
D4 | Procedure allowed at 50% with visit | Procedures |
D5 | Procedure already allowed - visit fee adjusted | Procedures |
D6 | Limit of payment for this procedure reached | Procedures |
D7 | Not allowed in addition to other procedure | Procedures |
D8 | Allowed with specific procedures only | Procedures |
D9 | Not allowed to a hospital department | Procedures |
DA | Maximum for this procedure reached - paid as repeat/chronic procedure | Procedures |
DB | Other dialysis procedure already paid | Procedures |
DC | Procedure paid previously not allowed in addition to this procedure - fee adjusted to pay the difference | Procedures |
DD | Not allowed as diagnostic code is unrelated to original eye exam | Procedures |
DE | Lab tests already paid - visit fee adjusted | Procedures |
DF | Corresponding fee code was not billed or paid at zero | Procedures |
DG | Diagnostic/Miscellaneous services for hospital patients are not payable on a fee-for-service basis in the Hospital Global budget. | Procedures |
DH | Ventilatory support allowed with Haemodialysis | Procedures |
DL | Allowed as laboratory tests in private office | Procedures |
DM | Paid/disallowed in accordance with MOH policy regarding an Emergency Department Equivalent | Procedures |
DN | Allowed as pudendal block in addition to procedure - as per stated OHIP policy | Procedures |
DP | Procedure paid previously allowed at 50% in addition to this procedure - fee adjusted to pay the difference | Procedures |
DR | Self-Referred Diagnostic Services Payable at 50% | Procedures |
DS | Not allowed - mutually exclusive code billed | Procedures |
DT | In-patient technical fee not allowed | Procedures |
DV | Service is included in Monthly Management Fee for Long-Term Care (LTC) patients | Procedures |
DW | Procedure paid previously not allowed in addition to monthly management for long-term care patients - fee adjusted to pay the difference. | Procedures |
DX | Diagnostic code not eligible with Fee Schedule Code | Procedures |
E1 | Service date prior to start of eligibility | Eligibility |
E2 | Incorrect version code for service date | Eligibility |
E3 | Version Code not on File for HN (Health Number) | Eligibility |
E4 | Service date after the eligibility termination date | Eligibility |
E5 | Service date not within an eligible period | Eligibility |
E6 | Service Date after Eligibility End Date - Eligibility Terminated as MOH Records Indicate Patient Deceased | Eligibility |
E9 | Service Date after Eligibility End Date - Eligibility Terminated Due to no Response to Notice to Register | Eligibility |
EA | Service date is not within an eligible period - Services provided on or after the 20th of this month will not be paid unless eligibility status changes | Eligibility |
EB | Coding added/changed in accordance with Schedule of Benefits | Eligibility |
ECLAM0002 | Mal Formed Header | File Upload |
ECLAM0003 | Missing Billing Number in the header | File Upload |
ECLAM0005 | Mal Formed Trailer - Claim Header-1 header count does not match number of Claim Header-1 headers in batch | File Upload |
ECLAM0006 | Mal Formed Trailer - Claim Header-2 header count does not match number of Claim Header-2 headers in batch | File Upload |
ECLAM0007 | Mal Formed Trailer - Item Record count does not match number of Item Records in batch | File Upload |
ECLAM0008 | Claim File must be 79 bytes | File Upload |
ECLAM0009 | Invalid Claim File format | File Upload |
EE | Assessment Allowed at Full Fee for Patient Proceeding to Hospital | Eligibility |
EF | Incorrect version code - services provided on or after the 20th of this month will not be paid unless the current version code is provided | Eligibility |
EF1 | ICHSC number not approved for billing on the date specified | ICHSC |
EF2 | ICHSC not licensed or grandfathered to bill FSC on the date specified | ICHSC |
EF3 | Insured services are excluded from ICHSC billings | ICHSC |
EF4 | Provider is not approved to bill ICHSC fee on date specified | ICHSC |
EF5 | ICHSC practitioner 991000 is not allowed to bill insured services | ICHSC |
EF7 | Referring physician number is required for the ICHSC fee billed | ICHSC |
EF8 | 'I' service codes are exclusive to ICHSCs | ICHSC |
EF9 | Mobile site number required | ICHSC |
EG1 | Group not Eligible | General |
EH1 | Service Date before Eligibility Effective Date | General |
EH2 | Mismatched Version Code guide | General |
EH4 | Service Date after Eligibility End Date | General |
EH5 | Service Date Not in Eligibility Period | General |
EH6 | Eligibility Terminated - Deceased | General |
EH9 | Health Number (HN) Not Activated | General |
EN | Network billing not allowed | Eligibility |
ENP | Invalid FSC for Nurse Practitioner (NP) | General |
EOBEC0002 | OBEC File is an invalid length | File Upload |
EOBEC0003 | Mal Formed Header - The 'OBE' in the transaction code field is invalid. | File Upload |
EOBEC0004 | OBEC Health Number length invalid. | File Upload |
EOBEC0005 | OBEC Health Number is not numeric. | File Upload |
EP | This payment is an adjustment of an earlier account due to provider registration update | Eligibility |
EP1 | Enrolment Transaction Not Allowed | General |
EP2 | Not for Enrolment / ReEnrolment | General |
EP3 | Incorrect Service Date - Check Date of Enrolment | General |
EP4 | Enrolment Restriction Applied | General |
EP5 | Incorrect FSC for Group Type | General |
EP6 | Health Number (HN) Not Activated | General |
EP7 | Code must be billed alone | General |
EPA | Network billing not approved | General |
EPC | Patient not rostered / rostered to another Network | General |
EPF | Enrolment Date Mismatch | General |
EPP | Incorrect Code for Eligibility (Ontario Works / Ontario Disability Support Program) | General |
EPS | Patient Not Eligible for Program | General |
EQ1 | Clinic/Doctor Not on File - Practitioner not registered with OHIP | General |
EQ2 | Specialty mismatch - Specialty Code is inactive or not registered on date of service | General |
EQ3 | Claim submitted as Pay Patient - Health care provider is registered as OPTED-IN for date of service | General |
EQ4 | Claim submitted as Pay Provider - Health care provider is registered as OPTED-OUT for date of service | General |
EQ5 | Lab inactive on Service date | General |
EQ6 | Incorrect Referral Number - Referring/requisitioning health care provider number is not registered with the Ministry of Health | General |
EQ9 | Lab Number not on File | General |
EQB | Solo practitioner inactive on service date; practitioner number is Midwife (700000-722899) referral only; claims submitted by Chiropractors using their Claim Submission Number (CSN); physician registered as group billing only | General |
EQC | Group not registered | General |
EQD | Group inactive on service date | General |
EQE | Affiliated Practitioner not in Group - Health care provider is not registered with the Ministry of Health as an affiliate of this group on date of service | General |
EQF | Affiliated Practitioner inactive - Health care provider is not actively registered with the Ministry of Health as an affiliate of this group on date of service | General |
EQG | Referring laboratory is not registered with the Ministry of Health | General |
EQI | Contract characteristics error | General |
EQJ | Practitioner Not Eligible On Service Date - New Graduate bills New Patient fee (Q013) or physician (not a new graduate) bills new Graduate-New Patient fee (Q033). | General |
EQK | Master Number (MNI) Does not Meet Criteria - A100 billed with a specialty code other than 00. | General |
EQL | Physician Not Eligible to Claim FSC - A100 billed with a specialty code other than 00 or billed by provider with any Emergency Department Alternate Funding Arrangement (EDAFA) group number. | General |
EQM | Not Registered for Use | General |
EQN | Registration Usage Error on Service Date | General |
EQP | Enrolment Type Not Eligible | General |
EQS | Practitioner Criteria Not Met | General |
ERF | Referring physician number is currently ineligible for referrals | General |
ESD | APP group affiliation on service date - Hospital Emergency Department is part of an alternative funding agreement | General |
ESF | Not eligible to bill | General |
ESH | Not Eligible For Blank HN | General |
ESN | Invalid Blank HN Claim - No HN required for FSC | General |
ET1 | Not Registered for Telemedicine | Telemedicine |
ET4 | Telemedicine Premium/Tracking Code Missing | Telemedicine |
ET5 | Telemedicine SLI Missing/Invalid - The telemedicine billing is submitted with a telemedicine tracking code but the SLI code is not 'OTN' or is not present. | Telemedicine |
EV | Check health card for current version code | Eligibility |
F1 | Additional fractures/dislocations allowed at 85% | Fractures / Aftercare |
F2 | Allowed in accordance with transferred care | Fractures / Aftercare |
F3 | Previous attempted reductions (open or closed) allowed at 85% | Fractures / Aftercare |
F5 | Two weeks aftercare included in fracture fee | Fractures / Aftercare |
F6 | Allowed as Minor/Partial Assessment | Fractures / Aftercare |
FF | Additional payment for the claim shown | Fractures / Aftercare |
G1 | Other critical/comprehensive care already paid | Critical Care / Coverage |
GF | Coverage lapsed - bill patient for future claims | Critical Care / Coverage |
H1 | Admission assessment or Emergency department assessment already paid | Hospital Visits |
H2 | Allowed as subsequent visit - initial visit previously claimed | Hospital Visits |
H3 | Maximum fee allowed per week after 5th week | Hospital Visits |
H4 | Maximum fee allowed per week after 6th week to pediatricians | Hospital Visits |
H5 | Maximum fee allowed per month after the 13th week | Hospital Visits |
H6 | Allowed as supportive or concurrent care | Hospital Visits |
H7 | Allowed as chronic care | Hospital Visits |
H8 | Hospital number and/or admission date required for in-hospital service | Hospital Visits |
H9 | Concurrent care already claimed by another doctor | Hospital Visits |
HA | Admission assessment claimed by another physician - hospital visit fee applied | Hospital Visits |
HB | Subsequent Visit Already Paid Same Day | Hospital Visits |
HCC | Not on Health Care Connect (HCC) database - Not Eligible; on HCC database but not Complex-Vulnerable; on HCC database but not in 'referred to' status | General |
HCE | Patient enrolled to billing physician but later than 3 months from the 'referred to' date on HCC database - Enrolment after 3 Months | General |
HF | Concurrent or supportive care already claimed in period | Hospital Visits |
HM | Invalid master number used on date of service | Hospital Visits |
I2 | Service is globally funded | Global Funding / IHF |
I3 | Fee Schedule Code is not on the IHF (Independent Health Facility) licence profile for the date specified | Global Funding / IHF |
I4 | Records show service has been rendered by another Practitioner, Group or IHF | Global Funding / IHF |
I5 | Service is globally funded and Fee Schedule Code is not on IHF licence profile | Global Funding / IHF |
I6 | Premium not applicable | Global Funding / IHF |
I7 | Claim date does not match patient enrolment date | Global Funding / IHF |
I8 | Confirmation not received | Global Funding / IHF |
I9 | Payment not applicable/expired | Global Funding / IHF |
J1 | Service Date is Before the Effective Date of OHIP Coverage | Coverage / Stale Date |
J2 | Service Date is After the Termination of Coverage Date | Coverage / Stale Date |
J3 | Approved for stale dated processing | Coverage / Stale Date |
J5 | Coverage Applied For; Premiums Not Yet Paid | Coverage / Stale Date |
J7 | Claim submitted three months after service date | Coverage / Stale Date |
J8 | Coverage Not In Effect; Services Provided On Or After The 20th Of This Month Will Not Be Paid Unless Subscriber Takes Corrective Action | Coverage / Stale Date |
J9 | Coverage Reinstated. Submit Claims Routinely | Coverage / Stale Date |
L1 | This service paid to another laboratory | Laboratory |
L2 | Not allowed to medical Laboratory Director | Laboratory |
L3 | Not allowed in addition to other laboratory procedure(s) | Laboratory |
L4 | Not allowed to attending physicians | Laboratory |
L5 | Not allowed in addition to other procedure paid to another laboratory | Laboratory |
L6 | Procedure paid previously to another laboratory, not allowed in addition this procedure - fee adjusted to pay the difference | Laboratory |
L7 | Not allowed - referred specimen | Laboratory |
L8 | Not to be claimed with prenatal/fetal assessment | Laboratory |
L9 | Laboratory services for hospital in-patients or out-patients are not payable on a fee-for-service basis - included in the hospital global budget | Laboratory |
LA | Lab service is funded by special Lab Agreement | Laboratory |
LS | Paid in accordance to special Lab Agreement | Laboratory |
M1 | Maximum fee allowed or maximum number of service has been reached same/any provider | Maximums |
M2 | Maximum allowance for radiographic examination(s) by one or more practitioners | Maximums |
M3 | Maximum fee allowed for prenatal care | Maximums |
M4 | Maximum fee allowed for these services by one or more practitioners has been reached | Maximums |
M5 | Monthly maximum has been reached | Maximums |
M6 | Maximum fee allowed for special visit premium - additional patient seen | Maximums |
MA | Maximum number of sessions has been reached | Maximums |
MC | Maximum number of case conferences has been reached in a 12 month period | Maximums |
MD | Daily maximum has been exceeded | Maximums |
ME | Maximum number of e-assessments paid | Maximums |
MM | Claim does not meet requirements of the Physician Schedule of Benefits | Maximums |
MN | Maximum number of occipital nerve block sessions has been reached | Maximums |
MO | Maximum number of Optical Coherence Tomography (OCT) services has been reached | Maximums |
MR | Minimum service requirements have not been met | Maximums |
MS | Maximum allowed for sleep studies in a specific period by one or more physicians has been reached | Maximums |
MU | Maximum Units Exceeded | Maximums |
MW | Maximum Number of Weeks has elapsed since payment of initial service | Maximums |
MX | Maximum of 2 arthroscopy 'R' codes with E595 has been reached | Maximums |
MY | Yearly maximum has been exceeded | Maximums |
O1 | Fee for obstetric care apportioned | Obstetrics |
O2 | Previous prenatal care already claimed | Obstetrics |
O3 | Previous prenatal care already claimed by another doctor | Obstetrics |
O4 | Office visits relating to pregnancy and claimed prior to delivery included in obstetric fee | Obstetrics |
O5 | Not allowed in addition to delivery | Obstetrics |
O6 | Medical induction/stimulation of labour allowed once per pregnancy | Obstetrics |
O7 | Allowed as subsequent prenatal visit - initial prenatal visit already claimed | Obstetrics |
O8 | Allowed once per pregnancy | Obstetrics |
O9 | Not allowed in addition to post-natal care | Obstetrics |
P2 | Maximum fee allowed for low birth weight care | Paediatric / Newborn |
P3 | Maximum fee allowed for newborn care | Paediatric / Newborn |
P4 | Fee for newborn care/low birth weight care is not billable with neonatal intensive care | Paediatric / Newborn |
P5 | Over-age for paediatric rates of payment | Paediatric / Newborn |
P6 | Over-age for well-baby care | Paediatric / Newborn |
P8 | Health Care Connect greater than 3 months | Paediatric / Newborn |
P9 | Complex New patient | Paediatric / Newborn |
PA1 | Invalid PA Service - Physician Assistant (PA) Pilot claim submissions may contain one or more PA Tracking FSCs but other OHIP insured service FSCs are not allowed on the same claim. | General |
PA2 | Invalid PA Claim - Physician Assistant (PA) Pilot claim submissions with the PA as the submitting physician must identify the solo billing number of the supervising physician in the 'Refer Physician' field. | General |
PA3 | Not registered for PA - The physician and/or referring physician fields on the PA Pilot claim submission contain billing numbers which are not affiliated to the PA Pilot group number. | General |
PA4 | PA Registration on Service Date Error | General |
PA5 | PA Affiliation Error | General |
PA6 | PA Affiliation on Service Date Error | General |
PAA | No Initial Fee Previously Paid - To ensure the smoking cessation initial discussion fee (E079) has been paid within 365 days prior to the smoking cessation counselling fee (Q042) or the smoking cessation follow up fee (K039) | General |
PM | Minimum roster size not met | Paediatric / Newborn |
Q7 | No fee allowed for treatment of immediate family | Miscellaneous |
Q8 | Lab not licensed to perform this test on date of service | Miscellaneous |
R01 | Missing Health Service Number (HSN) | RMB |
R02 | Invalid HSN | RMB |
R03 | Invalid/Missing Province Code | RMB |
R04 | Service Excluded from RMBS | RMB |
R05 | Provincial code invalid for RMBS - province code of 'ON' (Ontario) or 'PQ' (Quebec) and not an Outaouais claim | RMB |
R06 | Invalid Provider for RMBS | RMB |
R07 | Invalid Payment Type for RMBS | RMB |
R08 | Invalid Referral Number | RMB |
R09 | Claim Header 2 Missing - RMB | RMB |
R1 | Only one health exam allowed in a twelve-month period | Health Exams |
R2 | 10 Well Baby Visits Allowed Up To Two Years Of Age | Health Exams |
R3 | One Well Child Exam (Age 2-5 Years) Allowed Within A 12 Month Period | Health Exams |
RD | Duplicate, paid in Reciprocal Medical Billing System (RMBS) | Health Exams |
S1 | Bilateral surgery, one stage, allowed at 85% higher than unilateral | Surgical |
S2 | Bilateral surgery, two stage, allowed at 85% higher than unilateral | Surgical |
S3 | Second surgical procedure allowed at 85% | Surgical |
S4 | Procedure fee reduced when paid with related surgery or anaesthetic | Surgical |
S5 | Not allowed in addition to major surgical fee | Surgical |
S6 | Allowed as subsequent procedure - initial procedure previously claimed | Surgical |
S7 | Normal pre-operative and post-operative care included in surgical fee | Surgical |
S9 | Initial procedure not found | Surgical |
SA | Surgical procedure allowed at consultation fee | Surgical |
SB | Normal pre-operative visit included in surgical fee - visit fee previously paid - surgical fee adjusted | Surgical |
SC | Not allowed, major pre-operative visit already claimed | Surgical |
SD | Not allowed, Team/Assist Fee already claimed | Surgical |
SE | Major pre-operative visit previously paid and admission assessment previously paid - surgery fee reduced by the admission assessment | Surgical |
SF | Most Responsible Physician (MRP) visit not allowed during post-operative period - surgical fee adjusted | Surgical |
SMIDL0100 | System not initialized correctly; contact your technical support or software vendor. | File Upload |
SMIDL0203 | Service is not available; contact your technical support or software vendor. | File Upload |
SMIDL0204 | General System Error; contact your technical support or software vendor. | File Upload |
SN | Multiple Surgical Anaesthesia. Documentation of Separate Surgeries Same Day/Same Patient Required | Surgical |
SV | MRP visit not allowed during post-operative period - fee reduced to subsequent visit fee | Surgical |
SW | Intensive Care Unit per diem code paid to another physician - MRP subsequent visit reduced to subsequent visit | Surgical |
SX | ICU Per Diem code Paid To Another Physician, MRP Premium Not Allowed | Surgical |
T1 | Fee allowed according to surgery claim | Surgical |
TM1 | Duplicate Telemedicine Claim, Same patient | Telemedicine |
TM2 | Service not Billable for Missed/Cancelled/Abandoned Appointment | Telemedicine |
TM3 | Service not payable under Telemedicine Program | Telemedicine |
TM4 | Non Telemedicine Claim paid for same patient | Telemedicine |
TM5 | Telemedicine Claim Paid for same patient | Telemedicine |
TM6 | Registration not in effect on Service Date | Telemedicine |
TM7 | Dental Service not eligible for Telemedicine | Telemedicine |
TM8 | Not eligible for Store Forward | Telemedicine |
V02 | Invalid Region Code | General |
V05 | Error - Claim Number is less than Service Date | General |
V06 | Incorrect Clinic Code | General |
V07 | Invalid Practitioner Number | General |
V08 | Invalid Specialty Code: specialty code is missing/not 2 numerics; not a valid specialty code; specialty code is 27 and provider number is not 599993; specialty code is 90 and provider number is not 991000; specialty code is 49-55, 70, 71 and provider number does not begin with 4; specialty code is 56 and provider number does not begin with 80 or 81; specialty code is 80 or 81 and provider number does not begin with 82 | General |
V09 | Invalid Referral Number | General |
V1 | Allowed as repeat assessment - initial assessment previously claimed | Visits / Oculo-Visual |
V10 | Patient's last name is missing/not alphabetic (A-Z); first field position is blank | RMB |
V12 | Patient's first name is missing/not alphabetic (A-Z); first field position is blank | RMB |
V13 | Patient's date of birth is missing/invalid format; month not in the range 01-12; not 8 numerics; day is outside acceptable range for month | General |
V14 | Patient sex must be '1' (male) or '2' (female) | RMB |
V16 | Unacceptable Diagnostic Code - Not numeric | General |
V17 | Payee must be 'P' (Provider) or 'S' (Patient) | General |
V18 | Invalid Admission/First Visit date | General |
V19 | Invalid Chiropractor Diagnostic Code | General |
V2 | Allowed as extra patient seen in the home | Visits / Oculo-Visual |
V20 | Unacceptable Age for Diagnostic code - Service code is A007, patient is over 2 years old and diagnostic code is '916'; or service code is A003, patient is under 16 years old and diagnostic code is '917' | General |
V21 | Diagnostic Code Required | General |
V22 | Invalid Diagnostic Code | General |
V23 | Check Number Of Services | General |
V28 | Invalid Hospital Number | General |
V29 | Invalid In-Out-Patient Indicator | General |
V3 | Not allowed in addition to procedural fee | Visits / Oculo-Visual |
V30 | FSC/Diagnostic Code Combination Not A Benefit (NAB) | General |
V31 | Error in Claim Header - Missing any of: group number, health care provider number, specialty code | General |
V34 | Invalid Service Code; Service Code and Health Care provider type mismatch | General |
V35 | Invalid Out-of-Province/Out-of-Country Service | General |
V36 | Check input criteria required for sessional billing | General |
V39 | Number of items exceeds the maximum (99) | General |
V4 | Date of service was not a Saturday, Sunday or statutory holiday | Visits / Oculo-Visual |
V40 | Invalid Fee Schedule Code - service code is missing or not in the format ANNNA (A alphabetic A-Z, NNN numeric 001-999, A alphabetic A-C) | General |
V41 | Invalid Fee Billed - fee submitted is missing/not 6 numerics or not in the range '000000'-'500000' | General |
V42 | Invalid Number of Services - number of services is missing/not 2 numerics or not in the range '01-99' | General |
V47 | Fee not Divisible - Fee submitted is not evenly divisible (to the cent) by the number of services | General |
V5 | Only one major oculo-visual examination allowed in a 12-month period for under 19 or over 65 with medical condition; 1 in 18 month period for over 65 without medical condition | Visits / Oculo-Visual |
V50 | Service Date Pre Initial Visit - Physiotherapy | General |
V51 | Invalid location code - must be blank or four numerics; if present, must be valid based on MOHLTC Residency Code Manual | General |
V53 | Invalid FSC - Magnetic Tape/Disk | General |
V6 | Allowed as minor assessment - initial assessment already claimed | Visits / Oculo-Visual |
V62 | Invalid service location indicator - hospital diagnostic service billing from a participating hospital physician/group is not one of the five valid SLI codes (HDS, HED, HIP, HOP or HRP) | General |
V63 | Referring Laboratory Number must start with 5 (5###) | General |
V64 | Missing service location indicator | General |
V65 | Missing master number - SLI code HDS, HED, HIP, HOP or HRP is included with a diagnostic service billing but a master number was not included | General |
V66 | Missing admission date - SLI code HIP is included with a diagnostic service billing but an admission date was not included | General |
V67 | Missing master number and admission date - SLI code HIP is included with a diagnostic service billing but a master number and admission date were both not included | General |
V68 | Incorrect service location indicator - a diagnostic service is billed with a master number and admission date but the SLI code is not HIP | General |
V69 | Service Date Invalid for SLI | General |
V7 | Allowed at medical/specific re-assessment fee | Visits / Oculo-Visual |
V70 | Date of service is greater than the file/batch creation date | General |
V71 | Invalid Dental Master Number | General |
V73 | OTN SLI No Longer Active | General |
V8 | This service paid at lower fee as per stated OHIP policy | Visits / Oculo-Visual |
V9 | Only one initial office visit allowed within a twelve-month period | Visits / Oculo-Visual |
V98 | Wrong Preventive Care Date of Service | General |
VA | Procedure fee reduced - consultation/visit fees not allowed in addition | Visits / Oculo-Visual |
VB | Additional Oculo-Visual Assessment (OVA) is allowed once within the second year for patients aged 20-64, following a periodic OVA | Visits / Oculo-Visual |
VC | Procedure Paid Previously Not Allowed In Addition To Visit Fee. Fee Adjusted To Pay The Difference | Visits / Oculo-Visual |
VG | Only one geriatric general assessment premium per patient per 12-month period | Visits / Oculo-Visual |
VH0 | Header 2 and HN Present - Claim Header-2 present on MRI claim submitted with Health Number in Claim Header-1 | Health Number |
VH1 | Health Number is missing/invalid | Health Number |
VH2 | Health Number is Missing; Health Number is not present (Payment program is HCP or WCB) | Health Number |
VH3 | Invalid Payment Program - the payment program is missing or is not equal to HCP, RMB, WCB | Health Number |
VH4 | Invalid Version Code | Health Number |
VH5 | OHIP Number Required for Service Date | Health Number |
VH6 | Mixed Service Dates | Health Number |
VH7 | Health number and OHIP number on same claim | Health Number |
VH8 | Date of birth does not match the Health Number submitted | Health Number |
VH9 | Health Number is not registered with ministry | Health Number |
VHA | OHIP number not registered with ministry for health number | Health Number |
VHB | No HN Required for FSC; a non-encounter service claim submitted with a Health Number | Health Number |
VHC | SLI required for technical fee | General |
VJ5 | Invalid Service Date - missing/not 8 numerics; month not in range 01-12; day outside acceptable range for month; date of service greater than Ministry of Health system run date | General |
VJ7 | Stale-dated Claim | General |
VJ8 | Stale-dated Claim Encounter | General |
VM | Oculo-visual minor assessment is only allowed within eligibility period after a major oculo-visual examination | Visits / Oculo-Visual |
VN | Allowed as major oculo-visual examination for seniors with medical conditions | Visits / Oculo-Visual |
VP | Allowed with special visit only | Visits / Oculo-Visual |
VR | Visit reduced premium not applicable | Visits / Oculo-Visual |
VS | Date of service was a Saturday, Sunday or statutory holiday | Visits / Oculo-Visual |
VS1 | Invalid SEAMO Provider Code | General |
VS2 | Invalid Venue Type | General |
VS3 | Invalid Clinic Number | General |
VS4 | Invalid Healthcare Item | General |
VS5 | Invalid In-Patient/Out-Patient Indicator | General |
VS6 | Invalid HC Item Code Format | General |
VT1 | Only 1 VTC allowed | General |
VTC | Virtual Tech Code required | General |
VW1 | Invalid WCB Service | WCB |
VX | Complexity premium not applicable to visit fee | Visits / Oculo-Visual |
W3 | Warning: Service date is older than 3 months | Warnings |
W4 | Warning: Service location indicator code missing | Warnings |
X2 | Gastrointestinal (G.I.) tract includes cine and video tape | Imaging Maximums |
X3 | Gastrointestinal (G.I.) tract includes survey film of abdomen | Imaging Maximums |
X4 | Only one Bone Mineral Density (BMD) allowed within a 36 month period for a low risk patient | Imaging Maximums |
X5 | Only one Bone Mineral Density (BMD) allowed within a 12 month period for a high risk patient | Imaging Maximums |
X6 | Only one Bone Mineral Density (BMD) allowed within a 60 month period for a low risk patient | Imaging Maximums |
Questions
OHIP rejections, answered plainly
What are OHIP rejection codes?
They're the short codes the Ministry of Health returns on your remittance advice or error report to say why a claim wasn't paid in full. A rejection means nothing was paid; a reduction means it paid less than you submitted. Each code maps to a specific reason, like an invalid health-card version code or a missing referral.
How do I find why a claim was rejected?
The code sits against the claim on your monthly remittance advice (RA) or the error report. OHIPay reads both and shows the exact code and its meaning right on the rejected claim, so nobody has to decode it by hand.
What's the difference between a rejection and a reduction?
A rejection means the claim (or line) wasn't paid, so it needs correcting and resubmitting. A reduction means it was paid, just at a lower amount than you submitted. OHIPay sorts each outcome so paid, partially paid, and rejected claims land in the right place.
Catch these before they happen
OHIPay warns you before the Ministry rejects a claim
Before you submit, the advisory engine flags the entries most likely to trigger these codes and tags each one with the code it maps to. It never blocks a valid claim. You get to fix the likely rejection first.