Quick Answer: In Ontario HCV-Web, code 53 is a PASS response. It means the health card passed validation, the card itself is expired, and the physician may bill OHIP for insured services rendered today, subject to normal adjudication. Ontario’s current guidance also says that health cards that pass validation should be accepted and billed using standard OHIP procedures.
Response code 53 means: the health card passed validation, but the card is expired. Ontario’s HCV guidance treats this as a PASS, not a fail. The practical office meaning is simple: the patient is valid for today, and the physician should bill normally for insured services provided today. For code 53, the card’s printed issue and expiry dates are not the same thing as eligibility for the service date. The ministry guidance makes clear that a 53 response is still a pass. In other words: do not reject the patient for today solely because the physical card expired if HCV returns 53.
Response Code | Description | VERDICT |
*Between 50 and 59 | Physician will be paid for services rendered today. | PASS |
**91 | This health card’s validation attempts exceeded today’s limit. | Call the EDT office - 1 800 262 6524 or HYPE Support - 1 800 592 2138 |
**Between 0 and 49, Between 60 and 89, 90, 99, 9(A-M) | Physician will NOT be paid for services rendered. | FAIL Recommend the card-holder visit a service Ontario office or call the EDT office - 1 800 262 6524. |
*Code 53 is a PASS: Physician will be paid for services rendered today, card issue-expiry dates are the date the card is assigned, not the date of eligibility.
**Ontario’s HCV guidance says that if a patient was billed and later provides proof that they were eligible on that date, the provider must reimburse the patient in full.