OHIP Error Report Rejection Codes and Descriptions

When an OHIP claim cannot be accepted for processing, the Ministry may return a three-character rejection or validation code on the claim’s Error Report.

Use this article to search for the code and review its description.

How do I find an OHIP explanation code in HYPEMedical?

1. Open the Billing Cycle and search for Rejected claims. 
2. Locate and hover over the (i) in the Expl. Codes column for the explanation to load.
3. Review the description associated with the code.
4. Compare the explanation with the submitted claim and the payment.

A rejection code identifies why the claim was not accepted for processing. It does not confirm that correcting one field will make the service payable. The claim must still comply with the applicable OHIP billing requirements.

A-Series OHIP Rejection Codes

What causes OHIP rejection code AC4?

AC4 means that the referral number was not accepted.

Possible causes include:

• The referral number does not contain six numeric digits.
• The referral number is the same as the billing practitioner number.
• The referring number is between 722900 and 744292, indicating a Nurse Practitioner, but the Fee Schedule Code is not eligible for Nurse Practitioner referral.
• The referring number is between 700000 and 722899, indicating a Midwife, but the Fee Schedule Code is not eligible for Midwife referral.

C-Series OHIP Rejection Codes

E-Series Eligibility, Enrolment and Registration Codes

General eligibility codes

Patient enrolment codes

Practitioner, group and laboratory registration codes

What can cause EQB?

Possible EQB conditions include:

• The solo practitioner was inactive on the service date.
• A Midwife practitioner number between 700000 and 722899 was used as more than a referral number.
• A Chiropractor submitted the claim using a Claim Submission Number.
• The physician is registered for group billing only.

What do EQJ, EQK and EQL mean?

EQJ — Practitioner Not Eligible on Service Date

Examples include:

• A new graduate bills the New Patient fee Q013.
• A physician who is not a new graduate bills the New Graduate–New Patient fee Q033.

EQK — Master Number Does Not Meet Criteria

An example is A100 billed with a specialty code other than 00.

EQL — Physician Not Eligible to Claim Fee Schedule Code

An example is A100 billed with a specialty code other than 00, or billed by a provider associated with an Emergency Department Alternate Funding Arrangement group.

Health Care Connect Codes

Possible HCC conditions include:

• The patient is not on the Health Care Connect database.
• The patient is on the database but is not categorized as complex or vulnerable.
• The patient is on the database but is not in “referred to” status.

Physician Assistant Codes

V-Series Claim Validation Codes

Practitioner, patient and claim-header validation

What causes V08?

Possible V08 Invalid Specialty Code conditions include:

• The specialty code is missing.
• The specialty code does not contain two numeric digits.
• The specialty code is not valid.
• Specialty code 27 is used and the provider number is not 599993.
• Specialty code 90 is used and the provider number is not 991000.
• Specialty code 49, 50, 51, 52, 53, 54, 55, 70, or 71 is used and the provider number does not begin with 4.
• Specialty code 56 is used and the provider number does not begin with 80 or 81.
• Specialty code 80 or 81 is used and the provider number does not begin with 82.

What causes V13?

Possible V13 Invalid Date of Birth conditions include:

• The date of birth does not contain eight numeric digits.
• The month is not between 01 and 12.
• The day is outside the acceptable range for the selected month.

What causes V20?

Possible conditions include:

• Service code A007 was billed for a patient over two years old using diagnostic code 916.
• Service code A003 was billed for a patient under 16 years old using diagnostic code 917.

Fee Schedule Code, Fee and Service Validation

What causes V40?

V40 means that the Fee Schedule Code is missing or incorrectly formatted.

The expected format is:

• One alphabetic character
• Three numeric digits
• One alphabetic character

Example format: A123A

What causes V41?

Possible V41 Invalid Fee Billed conditions include:

• The fee is missing.
• The fee does not contain six numeric digits.
• The submitted value is outside the permitted range of 000000 to 500000.

What causes V42?

Possible V42 Invalid Number of Services conditions include:

• The number of services is missing.
• The value does not contain two numeric digits.
• The value is outside the permitted range of 01 to 99.

What causes V51?

The location code must either:

• Be left blank; or
• Contain four numeric digits.

When entered, it must be valid according to the Ministry residency-code requirements.

Service Location Indicator and Hospital Billing Codes

Which Service Location Indicators are valid for hospital diagnostic services?

The listed hospital diagnostic Service Location Indicators are:

• HDS
• HED
• HIP
• HOP
• HRP

What causes V65, V66, V67 or V68?

• V65: A hospital diagnostic SLI was entered, but the master number was missing.
• V66: SLI HIP was entered, but the admission date was missing.
• V67: SLI HIP was entered, but both the master number and admission date were missing.
• V68: A master number and admission date were entered, but the SLI was not HIP.

Service-Date and Stale-Date Codes

What causes VJ5?

Possible VJ5 Invalid Service Date conditions include:

• The service date is missing.
• The service date does not contain eight numeric digits.
• The month is not between 01 and 12.
• The day is outside the acceptable range for the month.
• The service date is later than the Ministry system run date.

What does VJ7 mean?

VJ7 means the claim was submitted outside the permitted claim-submission period and is considered stale-dated.

What does VJ8 mean?

VJ8 means the claim encounter was submitted outside the permitted claim-submission period and is considered stale-dated.

Venue and Virtual-Care Validation Codes

Health Number Validation Codes

What causes VHB?

VHB may be returned when a non-encounter service claim is submitted with a Health Number even though the Fee Schedule Code does not require one.

What causes VH0?

VH0 may be returned when Claim Header 2 is present on an MRI claim that was also submitted with a Health Number in Claim Header 1.

What causes VH2?

VH2 may be returned when:

• The Health Number is not present; and
• The payment program is HCP or WCB.

What causes VH3?

The payment program may be:

• Missing; or
• Different from HCP, RMB, or WCB.

Independent Health Facility and ICHSC Codes

Reciprocal Medical Billing System Codes

What causes R05?

Possible conditions include:

• Province code ON was entered.
• Province code PQ was entered and the claim is not an Outaouais claim.

Telemedicine Rejection Codes

What causes ET5?

ET5 may be returned when:

• A telemedicine tracking code was submitted; and
• The Service Location Indicator is missing or is not OTN.

Workplace Safety and Insurance Board Code

Frequently Asked Questions

What is an OHIP Error Report?

An OHIP Error Report identifies claims that were not accepted into the Ministry’s adjudication process because required information was missing, invalid, inconsistent, or not permitted.

Is an Error Report rejection the same as a Remittance Advice explanation?

No. An Error Report rejection generally means the claim was not accepted for adjudication. A Remittance Advice explanation code is associated with a claim that was processed and may have been paid, reduced, or not paid.

Can I correct and resubmit a rejected OHIP claim?

A rejected claim may generally be corrected and resubmitted when the underlying issue can be resolved. Before resubmitting, confirm that the service remains eligible and that the claim has not become stale-dated.

Why was my OHIP claim rejected for a version-code mismatch?

A version-code mismatch may be reported as EH2 or VH4. Confirm the patient’s current Health Number and version code before correcting the claim.

Which code means the patient is not rostered?

EPC means the patient is not rostered or is rostered to another network.

Which code means the claim is stale-dated?

• VJ7: Stale-dated claim
• VJ8: Stale-dated claim encounter

Which code means the Health Number is invalid?

Common Health Number codes include:

• VH1: Health Number missing or invalid
• VH2: Health Number missing
• VH8: Date of birth does not match the Health Number
• VH9: Health Number not registered with the Ministry
• EH2: Version-code mismatch
• EH9: Health Number not activated

Which code means the service code is invalid?

Common service-code rejection codes include:

• A3E: No such service code for the service date
• A3F: No fee exists for the code on the service date
• V34: Invalid service code
• V40: Invalid Fee Schedule Code
• EP5: Incorrect Fee Schedule Code for the group type

Which code means the referral number is missing or invalid?

Common referral-number codes include:

• AC4: Unaccepted referral number
• ARF: Missing referring physician number
• ARP: Referring physician number required
• EQ6: Referring provider number is not registered
• ERF: Referring physician is currently ineligible for referrals
• V09: Invalid referral number
• R08: Invalid referral number for Reciprocal Medical Billing