Interpret the ERR column

When OHIP rejects a code and payment, Visual Practice is informed of this through your OHIP reconciliation diskette or EDT process. When you process your reconciliation through Visual Practice, any rejection or response codes are copied into the ERR column in the OHIP Bills grid as shown below:

Response codes are 2 alphanumeric digits, and the OHIP response based on the codes are listed below:

Code	OHIP Message
10	Re-routed MRI Claim: Resubmit as RMB claim
11	Re-routed MRI Claim: Bill Patient or Quebec Medicare
12	Re-routed MRI Claim: Advise patient to contact Ministry of Health re: eligibility/card status
13	Re-routed MRI Claim: Service date is prior to newborn's date of birth
14	Re-routed MRI Claim: Fee billed too low - check for current SOB fee
15	Re-routed MRI Claim: Number of services exceeds maximum allowed.
16	Re-routed MRI Claim: Cannot be claimed alone/service date mismatch
17	Re-routed MRI Claim: E409/E410 not applicable: resubmit with appropriate assist/anaesthetic premium codes
18	Re-routed MRI Claim: Resubmit with manual review indicator and provide supporting documentation for two assistants
19	Re-routed MRI Claim: Resubmit with manual review indicator and forward copy of OP Report
20	Re-routed MRI Claim: Resubmit with manual review documentation
21	Re-routed MRI Claim: Records indicate patient is deceased - clarify or confirm
22	Re-routed MRI Claim: Code submitted requires prior approval
23	Re-routed MRI Claim: Hospital visits claimed by more than one physician - clarify role in patients care
24	Re-routed MRI Claim: Claims appearing in previous RAs as over/under payments should not be resubmitted. Use Inquiry form for payment adjustment requests.
25	Re-routed MRI Claim: Incomplete new registration - have parent/guardian contact Ministry of Health
26	Re-routed MRI Claim: One house call assessment (A901) allowed per visit - resubmit claim with appropriate service code
27	Re-routed MRI Claim: This duplicate submission is being returned; original submission currently on file pending medical consultation adjudication
28	Re-routed MRI Claim: Resubmit with manual review indicator with written explanation for detention; total time spent with patient including consultation/assessment indicated.
30	This service is not a benefit of OHIP
32	OHIP records show service(s) on this day claimed previously
35	OHIP records show this service rendered has been claimed previously (used on Pay Practitioner duplicate claims)
36	OHIP records show this service has been rendered by another Practitioner, Group or Lab
37	The listed benefit for this code is now 0 LMS units
40	This service allowed only once for same patient
48	Paid as submitted - clinical records may be requested for verification purposes
49	Paid according to the average fee for this service. Independent consideration will be given if clinical records/operative reports are presented
49	Paid according to the average fee for this service. Independent consideration will be given if clinical records/operative reports are presented.
50	Paid in accordance with the OHIP schedule of benefits
51	Fee schedule code changed in accordance with OHIP schedule of benefits
52	Fee for service assessed by medical consultant
53	Fee allowed according to appropriate item in a previous OHIP Schedule of Benefits
54	Interim Payment, Claim Under Review
55	This deduction is an adjustment on an earlier account
56	Claim under review
57	This payment is an adjustment on an earlier account
58	Claimed by another physician within group
59	Practitioner's notification - WCB (WSIB) Claims
60	Not a benefit of the reciprocal medical billing agreement
61	OOC claims paid greater $9999.99 (prior approval on file).
65	Service included in approved hospital payment
68	Hospital accommodation paid at standard Ward Rate
69	Elective services paid at 75% of OHIP Schedule of Rates
70	OHIP records show corresponding procedure(s) on this day claimed previously by another practitioner
80	Effective July 1,1998, technical fee decreased by 6.7% for hospitals or 4.2% for ihfs.
AP	This payment in accordance with legislation - if you disagree with the payment you may appeal to the General Manager
A3E	No Such Fee Schedule Code
A4A	To Assess, See Guideline
AC4	Unaccepted Ref No
AD3	Not allowed with Visit
AD4	Refer to MC
AD5	Proc. Allowed Prev.
AD8	Not allowed alone
ADC	Add Proc. at 50%
ADD	Add Proc. at 50%
ADM	Emerg. Equiv/other visits
AF1	Multiple Frac./Dis.
AF5	Frac. Fee Included
AG1	Crit. Care already PD
AG2	Crit. Care already PD
AHB	Overlapping Visits
AHD	Extra Visits in WK/MTH
AHE	Two Specialties, same period
AHF	CON/SUP Care Same Period
AH6	Emerg. Assess Same Day
AH7	Hosp. Assess Same Day
AH8	Invalid Adm Dte/Hosp No
AH9	Diagnostic Service same day
AI4	Claimed by other IHF/PHY
AMO	Multiple Surgeries, other doctor
AMS	Mulitiple Procedures
A02	Prev. OBS. Service
A08	One assess. at delivery
AP2	Max Fee Prem./NB Care
AP4	NIC Only allowed
ARD	Possible Duplicate with RMBS
AS8	Pre-op Cons/Assess
AS9	Post-op Visits
AV3	Proc. only Allowed
A2A	Outside of Age Limit
A2B	Wrong Sex for Service
A3E	No such F.S. Code
A3F	No fee for service
A3G	Fee Billed Low - Check
A3H	Max # Ser FSM Ref MC
A3J	Fee outside accepted Range
A3K	Auto Adj. On Prev. Man Ad
A34	Multiple Dup. Claims
A36	Claimed by another Practitioner
A4A	To Assess see guidelines
A4D	Ineligible Specialty
A4E	Manual Assess - Code 9
A4F	MRI Review by MC
A6A	No Claims Ref File ... A
A7A	Claim No. not Found ... A
A8A	Claim No. Previous on File
A81	Rule Err-Assess & Report
A87	FSC Mismatch ... A
A88	Adj. Payment Type Unequal.A
A89	Pay OOP Pract# Unequal.A
A91	Max. 99 Pat ID records
A93	Max 5000 Claim Items Record
A94	Claim item not on file ... A
A95	Claim item on file ... A
A96	Claim No. Previous on File
A97	Not all items Changed.A
A98	Pay Sub Disallowed Claim
A99	Wrong Patient Info ... A
B01	Invalid Record ID (Pos 3)
B02	Trailer Error - Claim Count H
B03	Trailer Error - Item Count T
B04	Trailer Error - Addr Count not allowed
B05	Trailer Error - Claim Count R
B11	Creation Date > System Date
B12	Invalid Creation Date
B13	Non-numeric Batch Sequence #
BAE	Trailer (E) not after T or missing
BBA	Batch (B) not first or after E / missing
BHA	Claim (H) not after B or T
BHE	Transaction ID not HE
BHT	Item (T) not after H, R or T
BIO	Invalid Operator Number
BLF	Record Not 79 Characters
BOF	Old Format Type After 91.06.18
BRA	Claim 2 (R) not after H
C1	Allowed as repeat/limited consultation
C2	Allowed at reassessment fee
C3	Allowed at minor assessment fee
C4	Consultations not allowed with this service - paid as assessed
C5	Allowed as multiple systems assessment
C6	Allowed as type 2 admission assessment
C7	An admission assessment (c003) or general re-assessment(c004) may not be claimed by any physician within 30 days following a pre-operative assessment.
D1	Allowed as repeat procedure; initial procedure previously claimed
D2	Additional procedures allowed at 50%
D3	Not allowed in addition to visit fee
D4	Procedure allowed at 50% with visit
D5	Procedure already allowed. visit fee adjusted
D6	Limit of payment for this procedure reached
D7	Not allowed in addition to other procedure
D8	Allowed with specific procedures only
D9	Not allowed to a hospital department
DA	Maximum for this procedure reached. paid as repeat/chronic procedure
DC	Procedure paid previously not allowed in addition to this procedure. fee adjusted to pay the difference
DE	Lab tests already paid - visit fee adjusted
DG	Diagnostic services for hospital in-patients are not payable on a fee-for-service basis-included in the hospital global budget.
DH	Ventilatory support allowed with haemodialysis
DL	Allowed as laboratory tests in private office
DM	Paid/disallowed in accordance with Ministry of Health policy regarding an emergency department equivalent
DN	Allowed as pudendal block in addition to procedure - as per stated OHIP policy
DP	Procedure paid previously allowed at 50% in addition to this procedure - fee adjusted to pay the difference.
F1	Allowed fractures/dislocations allowed at 85%
F2	Allowed in accordance with transferred care
F3	Previous attempted reductions (open or closed) allowed at 85%
F5	Two weeks aftercare included in fracture fee
F6	Allowed as minor/partial assessment
E1	Service date is prior to start of eligibility
E2	Incorrect version code for service date
E3	Version code not on file for hn
E4	Service date is after the eligibility termination date
E5	Service date is not within an eligible period
EB	Additional payment for the claim shown
EV	Check health card for current version code
EF1	IHF. Not Approved on S/D
EF2	IHF. Not Lic. For FSC on S/D
EF3	Insured Service Excl. From IHF
EF4	Prov. not IHF on S/D
EF5	Insured Service Excl. From #991000
EF7	Ref. Phys. # Required - IHF SRV
EF8	'I' FSC Claimed not IHF
EF9	Mobile Site Number Required
EH1	Service Date < Elig. Eff. Date
EH2	Check health card for current version code
EH4	Service Date > Elig. End Date
EH5	Service Date not in Elig. Period
ENB	Unregistered Newborn
EQA	Confirm Registered. Spec.
EQB	Solo Pract. Inactive on S/D
EQC	Group not registered on HRR
EQD	Group inactive on S/D
EQE	Pract. not in Group on S/D
EQF	Aff. Pract. Inactive on S/D
EQG	Ref. Lab. not required on HRR
EQ1	Clinic/Dr. not on file
EQ2	Specialty mismatch
EQ3	Pay. Sub. Claim - Dr. Option
EQ4	Pay Dr. Claim - Sub Option
EQ5	Lab Inactive on S/Date
EQ6	Incorrect Referral Number
EQ8	Lab. not licensed for FSC
EQ9	Lab. No. not on file
ERF	Referring Physician # Currently ineligible for referrals
F1	Additional fractures/dislocations allowed at 85%
F2	Allowed in accordance with transferred care
F3	Previous attempted reductions (open or closed) allowed at 85%
F5	Two weeks aftercare included in fracture fee
FF	Additional payment for the claim shown
G1	Other critical/comprehensive care already paid
H2	Allowed as subsequent visit; initial visit previously claimed
H3	Maximum fee allowed per week after 5th week
H4	Maximum fee allowed per week after 6th week to pediatricians
H5	Maximum fee allowed per month after 13th week
H6	Allowed as supportive or concurrent care
H7	Allowed as chronic care
H8	Hospital number and/or admission date required for in-hospital service
H9	Concurrent care already claimed by another doctor
HA	Admission assessment claimed by another physician - hospital fee applied
HF	Concurrent or supportive care already claimed in period
I2	Service is globally funded
I3	fsc is not on the ihf licence profile for the date specified
I4	Records show this service has been rendered by another practitioner, group or ihf
I5	Service is globally funded and fsc is not on ihf license profile
J3	Approved for stale date processing
L01	Location Code Must Be Numeric
L1	This service paid to another laboratory
L2	Not allowed to non-medical laboratory director
L3	Not allowed in addition to other laboratory procedure(s)
L4	Not allowed to attending physicians
L5	Not allowed in addition to other procedure paid to another laboratory
L6	Procedure paid previously to another laboratory, not allowed in addition to this procedure. fee adjusted to pay the difference
L7	Not allowed; referred specimen
L8	Not to be claimed with prenatal/fetal assessment as of july 1, 1993
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
LA	Lab service is funded by special lab agreement
LS	Paid in accordance to special lab agreement
M1	Maximum fee allowed for these services has been reached
M2	Maximum allowance for radiographic examination(s) by one or more practitioners
M3	Maximum fee allowed for pre-natal care
M4	Maximum fee allowed for these services by one or more practitioners has been reached
M5	Monthly maximum has been reached
O1	Fee for obstetric care apportioned
O2	Previous prenatal care already claimed
O3	Previous prenatal care already claimed by another doctor
O4	Office visits related to pregnancy and claimed prior to delivery include in obstetric fee
O5	Not allowed in addition to delivery
O6	Medical induction/stimulation of labour allowed once per pregnancy
O7	Allowed as subsequent prenatal visit. initial prenatal visit already claimed
O8	Allowed once per pregnancy
O9	Not allowed in addition to post-natal care
P2	Maximum fee allowed for low birth weight care
P3	Maximum fee allowed for newborn care
P4	Fee for newborn/low birth weight care is not billable with neonatal intensive care
P5	Over age for paediatric rates of payment
P6	Over age for well baby care
Q8	Lab not licensed to perform this test on date of service
R1	Only one health exam allowed in a 12 month period
R01	Missing Registration Number
R02	Digits Disagrees with Province
R03	Invalid Province Code
R04	FSC Excluded from RMB
R05	Not allowed for RMB
R06	Wrong Health Care Provider RMB
R07	Invalid Pay Type for RMB
R08	Invalid Referral Number - RMB
R09	Claim Header-2 Missing for RMB
R1	Only one health exam allowed in a 12 month period
RD	Duplicate, paid in rmbs
S1	Bilateral surgery, one stage, allowed at 85% higher than unilateral
S2	Bilateral surgery, two stage, allowed at 85% higher than unilateral
S3	Second surgical procedure allowed at 85%
S4	Procedure fee reduced when paid with related surgery or anaesthetic
S5	Not allowed in addition to major surgical fee
S6	Allowed as a subsequent procedure - initial procedure previously claimed
S7	Normal preoperative and postoperative care included in surgical fee
SA	Surgical procedure allowed at consultation fee
SB	Normal preoperative visit included in surgical fee. visit fee previously paid. surgical fee adjusted
SC	Not allowed, major preoperative visit already claimed
SD	Not allowed, team/assist fee already claimed
SE	Major pre-operative visit previously paid and admission assessment previously paid - surgery fee reduced by the admission assessment
T1	Fee allowed according to surgery claim
SR	Fee reduced based on Ministry of Health utilization adjustment, contact your provider
TH	Fee reduced per Ministry of Health payment policy - contact your physician
V02	Incorrect Region Code
V04	Error in Claim Number
V05	Error: Claim No./Service Date
V06	Incorrect Clinic Code
V07	Incorrect Doctor Code
V08	Incorrect Specialty Code
V09	Invalid Referral No.
V1	Allowed as repeat assessment; initial assessment previously claimed
V10	Surname Missing or Wrong ** RMB Claims Only
V12	First Name Missing or Wrong ** RMB Claims Only
V13	Incorrect Birth Date
V14	Sex not '1' or '2' ** RMB Claims Only
V16	Error in Diagnostic Code
V17	Error in Payment Type
V18	Invalid Admit/1st Visit Date
V19	Chiropractor Diagnostic Error
V2	Allowed as extra patient seen in the home
V20	Overage for Well Baby Care
V21	Diagnostic Code Required
V22	Diagnostic Code not Listed
V23	Check Number of Services
V25	Invalid action code
V26	Invalid Item Number
V27	Supply Same action Code
V28	Incorrect Hospital Number
V3	Not allowed in addition to procedural fee
V30	FSC/DX code Combination NAB
V31	Error in Claim Header
V33	Missing Payee Address
V34	Wrong Service Code
V35	Invalid OOP/OOC Service
V36	Check Sessional Input Criteria
V37	Incomplete Payee Address
V38	Inconsistent Claim Identificat
V39	Allowed Items Only 63
V4	Date of service was not a Saturday, Sunday or a statutory holiday
V40	Wrong Fee Schedule (Serv) Code
V41	Incorrect Fee Billed
V42	Error in Number of Services
V44	Invalid Assessment Code
V46	Invalid Fee Approved
V47	Fee not Divisible
V48	Missing Explanatory Code
V5	Only 1 ova allowed within a 12 mth period for age 19 and under or 65 and over; and 1 within 24 mths for age 20-64.
V50	SVC DTE Pre Initial Visit
V51	Invalid location code
V6	Allowed as minor assessment; initial assessment already claimed
V60	Invalid Explanatory Code
V62	Unacceptable L700A
V63	Invalid Referring Lab #
V7	Allowed at specific re-assessment fee
V70	Creation Date < Service Date
V8	This service paid at lower fee as per stated OHIP policy
V9	Only one initial office visit allowed within a 12 month period
V90	Please check age for service claim
V94	Invalid Bill 94 Adjustment
V95	One Bill 94 Adj. per claim
V96	Invalid Bill 147 Adjust
V97	One Bill 147 Adjustment per claim
VA	Procedure fee reduced - consultation/visit fees not allowed in addition
VB	Additional ova is allowed once within the 2nd year for patients aged 20-64 following a periodic ova.
VH0	Header-2 and HN Present
VH1	Health Number is Invalid
VH2	HN Req'd for this Service Date
VH3	Payment Pgm is Missing/Invalid
VH4	Invalid Version Code
VH5	OHIP # Required for Service Date
VH6	Mixed Service Dates in Claim
VH8	No Match on DOB with HN
VH9	HN Not Reg'd with Ministry of Health
VIC	Invalid Character - HEX < 20
VJ5	Wrong Date of Service
VJ7	Stale Dated Claim
VS	Date of service was a Saturday, Sunday or statutory holiday
VW1	Invalid Service Code for WCB
W02	Warning: Item [I] rec filler not spaces
X2	G.I. Tract includes cine and videotape
X3	G.I. Tract includes survey film of abdomen