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OHIP Billing – Error Report Rejection Conditions

Courtney Marie L.
Sep. 23, 2016
15-minute read
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Billing OHIP can result in having claims sent back with Claims Error Reports detailing various issues with submitted claims. Use our OHIP error code search tool » Below is a list of error codes that you may see on your reports, along with a description of what the issue is: A2A — Patient is underage or overage for this service code A2B — This service is not normally performed for this sex - please check your records A3E — No such service code for date of service A3F — No fee exists for this service code on this date of service A34 — Multiple duplicate claims A4D — Invalid specialty for this service code AC4 — A valid Referring/Requisitioning Health Care Provider number must be present for this service code. The fee schedule code is C813, C815 and the referral number is not in the Midwife range (700000-722899). Referring number is 722900-744292 (Nurse Practitioner) and the billing provider is not a lab (5000 series) and the FSCs are not on the following table: L005 L018 L030 L031 L040 L045 L053 L055 L067 L093 L107 L111 L117 L139 L148 L157 L181 L191 L194 L204 L208 L215 L221 L222 L223 L226 L243 L252 L253 L254 L306 L309 L311 L315 L318 L319 L321 L324 L329 L341 L345 L372 L377 L393 L395 L396 L397 L398 L399 L417 L418 L419 L445 L452 L462 L481 L482 L490 L493 L500 L544 L622 L624 L625 L626 L627 L628 L629 L630 L631 L634 L640 L641 L643 L650 L651 L652 L653 L654 L655 L667 L668 L679 L683 L691 L710 L713 L716 L817 L842. Acceptable codes for cardiology services for Nurse Practitioner referrals (others will reject): G310 G313 G700. ADM — Emergency equivalent/other visits AHA — Fee schedule code and time period mismatch AEV — Visit only allowed AH5 — Admit date mismatch AH8 — ƒIn-Patient Admission Date and/or Master Number are missing and are required for this service code AH9 — Diagnostic/miscellaneous service for hospital patient is not allowed on a fee-for service basis - included in the hospital global budget EH1 — Service date is prior to eligibility start date EH2 — Version code does not match health number version code for service date EH4 — Service date is greater than eligibility end date EH5 — Service date is not within an eligible period EPA — PCN billing not approved EPC — Patient not rostered/rostered to another PCN EPD — Roster/HRR payment discrepancy EPS —ƒ Patient not eligible for program EQ1 —ƒ Solo or affiliated Health Care Provider is not registered with the ministry EQ2 —ƒ Specialty Code is inactive or not registered on date of service EQ3 —ƒ Health Care Provider is registered as OPTED-IN for date of service. ƒ Claim submitted as Pay Patient. EQ4 —ƒ Health Care Provider is registered as OPTED-OUT for date of service. ƒ Claim submitted as Pay Provider. EQ5 —ƒ Laboratory Licence Number not actively registered with the ministry on this date of service EQ6 —ƒ Referring/Requisitioning Health Care Provider Number is not registered with the ministry EQ9 —ƒ Laboratory Licence Number is not registered with the ministry EQB —ƒ Solo Health Care Provider Number is not actively registered with the ministry on this date of service. ƒ Practitioner number is Midwife (700000-722899) referral only. EQC —ƒ Group Number is not registered with the ministry EQD —ƒ Group Number is not actively registered with the ministry on this date of Service EQE —ƒ Health Care Provider is not registered with the ministry as an affiliate of this Group on this date of service EQF —ƒ Health Care Provider is not actively registered with the ministry as an affiliate of this Group on date of service EQG —ƒ Referring Laboratory is not registered with the ministry EQS —ƒ Pract criteria not met ERF —ƒ Referring physician number is currently ineligible for referrals ESD —ƒ APP group affiliation on service date ESF —ƒ A non-encounter service claim submitted by a physician not eligible to bill FSC.ƒ Group number is in the range CAAA – CAJ9 and the FSC is not K400A. VJ5 —ƒ Date of Service is missing/not eight (8) numerics. ƒ Month is not in the range 01-12.ƒ Day is outside acceptable range for month. Date of Service is greater than ministry system run date. VJ7 —ƒ Date of Service is six (6) months prior to ministry system run date V02 —ƒ Incorrect ministry office code. Missing/not D, E, F, G, J, N, P, R, or U V05 —ƒ Date of service is greater than Ministry of Health system run date V07 —ƒ Health Care Provider number is missing/not 6 numerics V08 —ƒ Specialty code is missing/not 2 numerics. Not a valid specialty code.ƒ Specialty Code is 27 and provider number is not 599993.ƒ Specialty Code is 90 and provider number is not 991000.ƒ Specialty Code is 49, 50, 51, 52, 53, 54, 55, 70, or 71 and Health Care Provider number does not begin with 4.ƒ Specialty Code is 56 and Health Care Provider number does not begin with 80 or 81.ƒ Specialty Code is 57 and Health Care Provider number does not begin with 86 or 839985.ƒ Specialty Code is 58 and Health Care Provider number does not begin with 87.ƒ Specialty Code is 59 and Health Care Provider number does not begin with 88 or 89 or not in range 830000 - 839984.ƒ Specialty Code is 80 or 81 and Health Care Provider number does not begin with 82. V09 —ƒ Referring Health Care Provider number is not six (6) numerics.ƒ Health Care Provider number is 82XXXX and referring Health Care Provider number is missing or begins with 4 or 8.ƒ Group number begins with 5 or 7 or 8000 - 8599 and referring Health Care Provider is missing or begins with 4 or 8. Group number is 6008, 6100, 8600-8999 or 9XXX and referring Health Care Provider number is missing or begins with 4 or 8 (except for 830000 - 839984, 86XXXX, 88XXXX, 89XXXX). ƒ Referring number is 700000-722899 (MIDWIFE) and (1) the billing provider is not a LAB (5000 series) and the FSCs are not the following: L005 L030 L031 L103 L111 L253 L309 L311 L318 L319 L329 L341 L372 L393 L396 L399 L417 L418 L431 L453 L471 L482 L490 L494 L495 L621 L622 L625 L628 L634 L637 L640 L653 L655 L679 L683 L691 L700 L713 L800 L812. (2) for ultrasounds the FSCs are not the following: J138/J438 J157/J457 J158/J458 J159/J459 J160/J460 J161/J461 J163/J463. (3) special visit premium codes are not the following: C990 C991 C992 C993 C994 C995 C996 C997. V10 —ƒ Referring number is 900100-900600 (Alternate Health Care Professions).ƒ Patient’s last name is missing/not alphabetic (A - Z).ƒ The first field position is blank. V12 —ƒ RMB claim only. Patient’s first name is missing/not alphabetic (A - Z).ƒ The first field position is blank. V13 —ƒ RMB claim only.ƒ Patient’s date of birth is missing/invalid format.ƒ Month not in the range of 01 - 12.ƒ Not 8 numerics. V14 —ƒ Day is outside acceptable range for month.ƒ Patient Sex must be 1 (male) or 2 (female). V16 —ƒ RMB claim only.ƒ Not numeric.ƒ Health Care Provider number is 82XXXX and diagnostic code is not four (4) nu merics or is three (3) numerics and not 070, 072, or 880 to 971.ƒ Fee schedule code is G423, G424 and diagnostic code is not 360, 371, or 376. V17 —ƒ Payee must be P (Provider) or S (Patient) V18 —ƒ In-patient admission date is not eight (8) numerics.ƒ Month of admission is not in the range of 01-12.ƒ Day of admission is outside the acceptable range for month.ƒ In-patient admission date is later than ministry system run date. V19 —ƒ Chiropractic Diagnostic Code is missing/invalid.ƒ Chiropractic Diagnostic Code is not C followed by two (2) numerics.ƒ Health Care Provider number is 830000 - 839984, 88XXXX or 89XXXX and diagnostic code not C01-C15, C20-C24, C30-C33, C40-C48, C50-C54 or C60-C62. V20 —ƒ Service code is A007, patient is over two (2) years old and diagnostic code is 916; or service code is A003 and the patient is under sixteen (16) years old and the diagnostic code is 917. V21 —ƒ Diagnostic Code is required for this service V22 —ƒ Diagnostic Code is not a valid code V23 —ƒ Service code ends in B or C and the number of services is not greater than 01 (refer to Section 5.10 – Fee Schedule Code Suffix B/C Exceptions) V28 —ƒ Master Number is not four (4) numerics or is not a valid master number on date of service V30 —ƒ FSC/DX Code Combination NAB V31 —ƒ Missing all of the following: Group Number, Health Care Provider Number, Specialty Code, Health Number V34 —ƒ Service code begins with V1 and Health Care Provider number does not begin with 88 or 89, or in range 830000 - 839984 (and the reverse of this condition).ƒ Service code begins with V2 and Health Care Provider number does not begin with 86 or is 839985 (and the reverse of this condition).ƒ Service code begins with V3 and Health Care Provider number does not begin with 87 (and the reverse of this condition).ƒ Service code begins with V4 and Health Care Provider number does not begin with 80, 81, 84, or 85 (and the reverse of this condition).ƒ Service code begins with V8 and Health Care Provider number does not begin with 82 (and the reverse of this condition). ƒService code is prefixed with T and Health Care Provider number does not begin with 4, excluding Fee Schedule Codes J99 (and the reverse of this condition).ƒ Service code begins with H4 and Health Number is not a sessional reference number. V36 —ƒ Check input criteria required for sessional billing V39 —ƒ Number of Items exceeds the maximum (99) V40 —ƒ Service code is missing.ƒ Service code is not in the format ANNNA where: A is alphabetic (A-Z), NNN is numeric (001-999), A is alphabetic (A-C). V41 —ƒ Fee Submitted is missing/not six (6) numerics. ƒFee Submitted is not in the range 000000 - 500000 ($$$$cc). V42 —ƒ Number of Services is missing/not two (2) numerics. Number of Services is not in the range 01-99 V47 —ƒ Fee Submitted is not evenly divisible (to the cent) by the number of services V51 —ƒ Invalid Service Location Indicator (SLI) - must be blank or four numerics - if present, must be valid based on MOH Residency Code Manual V62 —ƒ Invalid service location indicator – assigned when a Service Location Indicator code included with a hospital diagnostic service billing from a participating hospital physician/group is not one of the six valid SLI codes: HDS, HED, HIP, HOP, HRP or OTN V63 —ƒ Referring Laboratory Number must start with 5 (5###) V64 —ƒ Missing service location indicator – assigned when a hospital diagnostic service is billed by a participating hospital physician/group but a service location indicator code was not included V65 —ƒ Missing master number – assigned when SLI code HDS, HED, HIP, HOP, HRP or OTN is included with a diagnostic service billing from a participating hospital physician/group but a master number was not included V66 —ƒ Missing admission date – assigned when SLI code HIP is included with a diagnostic service billing from a participating hospital physician/group but an admission date was not included V67 —ƒ Missing master number and admission date – assigned when SLI code HIP is included with a diagnostic service billing from a participating hospital/group but a master number and admission date were both not included V68 —ƒ Incorrect service location indicator – assigned when a diagnostic service is billed from a participating hospital physician/group with a master number and admission date but the SLI code is not HIP V70 —ƒ Date of Service is greater than the file/batch creation date A14 —ƒ Records show this service has been rendered by another practitioner, group or IHF EF1 —ƒ IHF number not approved for billing on the date specified EF2 —ƒ IHF not licensed or grandfathered to bill FSC on the date specified EF3 —ƒ Insured services are excluded from IHF billings EF4 —ƒ Provider is not approved to bill IHF fee on date specified EF5 —ƒ IHF practitioner 991000 is not allowed to bill insured services EF7 —ƒ Referring physician number is required for the IHF facility fee billed EF8 —ƒ I Service codes are exclusive to IHFs EF9 —ƒ Mobile site number required R01 —ƒ Missing HSN R02 —ƒ Invalid HSN R03 —ƒ Province Code missing. ƒNot a valid Province Code (refer to Section 5.14 – Province Codes and Numbering). R04 —ƒ Fee Schedule Code excluded from RMB R05 —ƒ ‘ON’ (Ontario Province Code) not valid for RMB R06 —ƒ Wrong Health Care Provider for RMB (begins with 3, 4, 8, or 9) R07 —ƒ Invalid pay type for RMB (must be ‘P’) R08 —ƒ Invalid referral number (applies to Outaouais Region, Quebec only).ƒ Not 7 numerics. R09 —ƒ Claim Header-2 is missing and the payment program is RMB ET1 —ƒ Provider not registered for Telemedicine Program ET4 —ƒ Telemedicine premium/tracking code missing ET5 —ƒ Telemedicine SLI code missing or invalid TM1 —ƒ Duplicate telemedicine claim for same patient TM2 —ƒ Service not billable for missed/cancelled/abandoned appointment TM3 —ƒ Invalid physician telemedicine service TM4 —ƒ Non-telemedicine claim already paid for this patient TM5 —ƒ Telemedicine claim already paid for this patient TM6 —ƒ Telemedicine registration not in effect on service date TM7 —ƒ Dental service not allowed under Telemedicine Program TM8 —ƒ Provider not eligible for telemedicine store and forward VW1 — Service not valid for WCB VHB —ƒ A non-encounter service claim submitted with a Health Number VHO —ƒ Claim Header-2 present on MRI claim submitted with Health Number in Claim Header-1 VH1 —ƒ Health Number is missing/invalid (does not pass MOD 10 Check routine).ƒ Health Number is a number reserved for testing purposes (refer to Section 3.1 – Initial Claims File). VH2 —ƒ Health Number is not present (Payment program is HCP or WCB)</ p> VH3 —ƒ The payment program is missing or is not equal to HCP, RMB, WCB VH4 —ƒ Invalid Version Code VH5 —ƒ Claim Header-2 is missing (service is before January 1, 1991 and Payment Program is HCP) VH8 —ƒ Date of birth does not match the Health Number submitted VH9 —ƒ Health Number is not registered with ministry   “This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.”

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Courtney Marie L
Writer and editor with a demonstrated history of working in the Canadian healthcare sector and the publishing industry. Skilled in writing, editing, proofreading, Spanish to English translation, and teaching English as a second language. Strong communications professional with a Bachelor of Arts in Geography and Political Science from the University of Manitoba.
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