FAQ

Claims Error Explanatory Codes

Rejection Conditions

A      C      D      E      H      P      R      T      V
  • 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
  • A3L Other New Pt Fee Already Pd
  • A34 Multiple duplicate claims
  • A4D Invalid specialty for this service code
  • AC1 Maximum reached – resubmit alternate fsc
  • AC4 A valid referring/requisitioning health care provider number must be present for this service code. Referring number is 722900-744292 (Nurse Practitioner) and FSC are not any of the following:
    ‑ Laboratory Services (L***);
    ‑ Cardiology codes G310, G313, G700;
    ‑Physiotherapy Code;
    ‑Xray - X codes;
    ‑Ultra Sound Codes - J codes
  • AD1 Corresponding Procedure Not Claimed
  • AD9 Premium not allowed alone
  • ADF Corresponding Procedure Invalid, Omitted or Paid at zero
  • AH5 Admit date mismatch
  • AH8 Hospital and/or Admission date is missing or invalid. - Invalid Adm Dte/Hosp No
  • AMR Minimum service requirements have not been met.
  • TOP
  • CNA Counselling Not Allowed
  • TOP
  • DF Correponding Procedure Invaild, Omitted or Paid at Zero
  • TOP
  • EF1 IHF number not approved for billing on the date specified
  • EF2 IHF not licensed or grandfathered to bill FSC on the date specified
  • EF3 Insured services are excluded from IHF billings
  • EF4 Provider is not approved to bill IHF fee on date specified
  • EF5 IHF practitioner 991000 is not allowed to bill insured services
  • EF7 Referring physician number is required for the IHF fee billed
  • EF8 ‘I’ service codes are exclusive to IHFs
  • EF9 Mobile site number required
  • EH1 Srv. Date Elig. Eff. Date
  • EH2 Mismatched Version Code
  • EH4 Srv. Date > Elig. End Date
  • EH5 Srv. Dt. Not in Elig. Period
  • ENP Invalid FSC for NP
  • EPA Network billing not approved
  • EPC Patient not rostered/rostered to another Network
  • EPF Enrlmt Date Mismatch
  • EPP Incorrect Code for Eligibility (Ontario Works/Ontario Disability Support Program)
  • EPS Patient Not Elig for Program
  • EP1 Enrlmt Trans Not Allowed
  • EP2 Not for Enrol/Re Enrol
  • EP3 Check Srv Dte / Enrol Dte
  • EP4 Enrolmnt Restriction
  • EP5 Incorrect FSC for Grp Typ
  • EQ1 Practitioner not registered with OHIP - Clinic/Dr Not on File
  • EQ2 Specialty code is inactive or not registered on date of service
  • EQ3 Health care provider is registered as OPTED-IN for date of service – claim submitted as Pay Patient
  • EQ4 Health care provider is registered as OPTED-OUT for date of service – claim submitted as Pay Provider
  • EQ5 Lab inactive for service date
  • EQ6 Referring/requisitioning health care provider number is not registered with the Ministry of Health
  • EQ9 Lab No. not on File
  • EQB Solo health care provider number is not actively registered with the Ministry of Health on this date of service Practitioner number is Midwife (700000 - 722899) referral only Claims submitted by Chiropractors using their CSN
  • EQC Group number is not registered with the Ministry of Health.
  • EQD Group number is not actively registered with the Ministry of Health on this date of service
  • EQE Health care provider is not registered with the Ministry of Health as an affiliate of this group on date of service
  • EQF Health care provider is not actively registered with the Ministry of Health as an affiliate of this group on date of service
  • EQG Referring laboratory is not registered with the Ministry of Health
  • EQJ New Graduate bills New Patient fee (q013) or Physician (not a new graduate) bills new Graduate – New Patient fee (Q033) - Pract. Not Elig. On S/D
  • EQK A100 billed with a specialty code other than 00. - MNI Does not Meet Criteria
  • EQL A100 billed with a speciality code other than 00 or billed by provider with any EDAFA group number. - Phy Not Eligible to Claim
  • EQM Not Registered for Use
  • EQN Reg Usage Err on S/D
  • EQS Provider does not have a sub-specialty of PSY. - Pract Criteria Not Met
  • ERF Referring physician number is currently ineligible for referrals
  • ESD APP group affiliation on service date
  • ESF A non-encounter service claim submitted by a physician not eligible to bill FSC
  • ESH If a claim is submitted by a Mental Health Sessional Group for a code other than K400A, reject the claim to the error report. - Not Elig. For Blank HN
  • ESN If health number is on the claim for K400A- No HN required for FSC. Invalid Blank HN Claim
  • ET1 The telemedicine billing is submitted by a physician who is not registered as a Telemedicine physician. - Not Reg for Telemedicine
  • ET4 The telemedicine billing does not include a telemedicine premium code (B100, B101, B102, B200, B201, B202) - Telemed Fee code missing
  • ET5 The telemedicine billing is submitted with a telemedicine premium/tracking code but the SLI code is not ‘OTN’ or is not present. - Telemed SLI Missing/Invld
  • TOP
  • 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
  • HCE Patient enrolled to billing physician but later than 3 months from the “referred to” date on Health Care Connect database - Enrolment after 3 Months
  • TOP
  • PAA To ensure the smoking cessation initial discussion fee (E079) has been paid within 365 days prior to the smoking cessation counseling fee (Q042) or the smoking cessation follow up fee (K039) - No Initial Fee Prev. Pd.
  • PA1 Physician Assistant (PA) Pilot claim submissions may contain one or more PA Tracking FSC’s but other OHIP insured service FSCs are not allowed on the same claim. - Invalid PA Srv
  • PA2 Physician Assistant Pilot (PA) claim submissions with the PA as the submitting physician must identify the solo billing number of the supervising physician in the “Refer Physician” field. - Invalid PA Claim
  • PA3 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. Not registered for PA
  • PA4 PA Registrn on S/D Err
  • PA5 PA Affiliation Error
  • PA6 PA Affil’n on S/D Err
  • TOP
  • R01 Missing HSN
  • R02 Invalid HSN
  • R03 Invalid/Missing Province Code
  • R04 Service Excluded from RMBS
  • R05 Provincial code is 'ON' (Ontario) which is not valid for RMBS
  • R06 Wrong Provider for RMBS
  • R07 Invalid Pay Type for RMBS
  • R08 Invalid Referral Number
  • TOP
  • TM1 Dup Telemed Claim, Same patient (uninsured)
  • TM2 Can’t Bill with MSD/CNC AP
  • TM3 Service not Telemedicine Payable
  • TM4 Non Telemed Claim paid for same patient
  • TM5 Telemed Claim Paid for same patient
  • TM6 Registration not in effect on Service Date
  • TM7 Dental Service not eligible for Telemedicine
  • TM8 Not eligible for Store FD
  • TOP
  • V02 Invalid Region Code
  • V05 Error - Clm No/Serv Date
  • V06 Incorrect Clinic Code
  • V07 Invalid Pract. Number
  • 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, 50, 51, 52, 53, 54, 55, 70 and 71 and the health care provider number does not begin with 4
    ‑ Specialty code is 56 and health care provider number does not begin with 80 or 81
    ‑ Specialty code is 57 and health care provider number does not begin with 86 or 839985
    ‑ Specialty code is 58 and health care provider number does not begin with 87
    ‑ Specialty code is 59 and health care provider number does not begin with 88 or 89 or not in range 830000 – 839984
    ‑ Specialty code is 80 or 81 and health care provider number does not begin with 82
  • V09 Invalid Referral Number
  • V10
    ‑ Patient’s last name is missing/not alphabetic (A - Z)
    ‑ First field position is blank
    ‑ RMB claim only
  • V12
    ‑ Patient’s first name is missing/not alphabetic (A - Z)
    ‑ First field position is blank
    ‑ RMB claim only
  • V13
    ‑ Patient’s date of birth is missing/invalid format
    ‑ Month not in the range of 01 – 12
    ‑ Not 8 numerics (new MRI format)
    ‑ Day is outside acceptable range for month
  • V14 Patient sex must be ‘1’ (male) or ‘2’ (female) RMB claim only
  • V16 Unacceptable Diagnostic Code Not numeric Health care provider number is 82XXXX and diagnostic code is not 4 numerics or is 3 numerics and not 070, 072, 880 or 971 Fee schedule code is G423, G424 and diagnostic code is not 360, 371 or 376
  • V17 Payee must be ‘P’ (Provider) or ‘S’ (Patient)
  • V18 In-patient admission date is not 8 numerics Month of admission is not in the range of 01 - 12 Day of admission is outside the acceptable range for month In-patient admission date is later than Ministry of Health system run date
  • V20 Service code is A007, patient is over 2 years old and diagnostic code is ‘916’ or service code is A003 and the patient is under 16 years old and the diagnostic code is ‘917’
  • V21 Diagnostic Code Required
  • V22 Invalid Diagnostic Code
  • V23 Check No. Of Services
  • V28 Invalid Hospital Number
  • V29 Invalid In-Out-Pat-Ind
  • V30 FSC/DX Code Combination NAB
  • V31 Missing any of the following: group number, health care provider number, specialty code
  • V34
    ‑ 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)
    ‑ Service code begins with ‘V2’ and health care provider number does not begin with 86 or is 839985 (and the reverse of this condition)
    ‑ Service code begins with ‘V3’ and health care provider number does not begin with 87 (and the reverse of this condition)
    ‑ 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)
    ‑ Service code begins with ‘V8’ and health care provider number does not begin with 82 (and the reverse of this condition)
    ‑ Service code begins with ‘T’ and health care provider number does not begin with 4, excluding fee schedule codes J99-- (and the reverse of this condition)
    ‑ Service code begins with ‘H4’ and health number is not a sessional reference number
  • V35 Invalid OOP/OOC Service
  • V36 Check input criteria required for sessional billing
  • V39 Number of items exceeds the maximum (99)
  • V40 Service code is missing 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 Fee submitted is missing/not 6 numerics Fee submitted is not in the range ‘000000’ - ‘500000’ ($$$$cc)
  • V42 Number of services is missing/not 2 numerics Number of services is not in the range ‘01 - 99’
  • V47 Fee submitted is not evenly divisible (to the cent) by the number of services
  • V50 Service Date Pre Initial Visit
  • V51 Invalid location code - must be blank or four numerics. If present, must be valid based on MOHLTC Residency Code Manual
  • V53 Invalid FSC-Magnetic Tape/Disk
  • V62 Invalid service location indicator – assigned when a Service Location Indicator (SLI) code included with a hospital diagnostic service billing from a participating hospital physician/group is not of the five valid SLI codes (HDS, HED, HIP, HOP or HRP)
  • V63 Referring Laboratory Number must start with 5 (5###)
  • V64 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 Missing master number – assigned when SLI code HDS, HED, HIP, HOP or HRP is included with a diagnostic service billing from a participating hospital physician/group but a master number was not included
  • V66 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 Missing master number and admission date – assigned when a 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 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
  • V69 Serv Dte Invalid for SLI
  • V70 Date of service is greater than the file/batch creation date
  • V71 Invalid Dental Master No.
  • VHB No HN Req’d for FSC
  • VH1 Health Number is Invalid
  • VH2 HN is Missing
  • VH3 Invalid Payment Program
  • VH4 Invalid Version Code
  • VH8 No Match on DOB with HN
  • VH9 HN Not Reg’d with MOH
  • VJ5
    ‑ Date of Service is missing/not 8 numerics
    ‑ Month is not in the range 01 - 12
    ‑ Day is outside acceptable range for month
    ‑ Date of Service is greater than Ministry of Health system run date
  • VJ7 Stale-dated Claim
  • VJ8 Stale-dated Claim Encounter
  • VS1 Invalid SEAMO Prvdr Code
  • VS2 Invalid Venue Type
  • VS3 Invalid Clinic Number
  • VS4 Invalid Healthcare Item
  • VS5 Invalid IP/OP Indicator
  • VS6 Invalid HC Item Cde Fmt
  • VW1 Invalid WCB Service
  • TOP