OHIP Rejection Code List

This error occurs when the service date on the claim falls outside the allowable service period for the specific service code. To address this, ensure that the service date is within the valid period for the service code being billed.

This rejection happens when the patient’s age is outside the acceptable age range for the service code being billed. Review the patient’s date of birth and the service code requirements to ensure the patient meets the age criteria.

This error indicates that the service code being billed is not typically performed for the patient’s sex. Double-check the patient’s sex and the service code requirements to ensure they align.

This rejection occurs when the service code being billed is not valid for the date of service. Verify that the service code is active and billable on the specified date of service.

This error means that the service code being billed does not have an associated fee for the date of service. Ensure that the service code is billable and has a fee schedule for the date of service.

This rejection indicates that the fee billed for the service code is lower than the correct fee amount. Review and adjust the fee billed to match the appropriate fee schedule.

This error occurs when the number of services billed for a specific service code exceeds the maximum number allowed per the Fee Schedule Master. Check the service code requirements and adjust the number of services accordingly.

Similar to A3H, this rejection happens when the number of services billed for an X-ray service code exceeds the maximum allowed per the Fee Schedule Master. Review the service code requirements and adjust the number of services.

This rejection occurs when multiple duplicate claims have been submitted for the same service. Review and remove any duplicate claims before resubmitting.

This error suggests that the service being billed has already been claimed by another practitioner. Coordinate with other practitioners involved in the patient’s care to avoid duplicate billing.

This rejection happens when the service code being billed is not compatible with the practitioner’s registered specialty. Verify the practitioner’s specialty and the service code requirements to ensure they align.

This error indicates that the maximum number of services for the billed service code has been reached. Consider submitting an alternate Fee Schedule Code (FSC) if applicable.

This rejection occurs when the referral number provided is not accepted for various reasons, such as not being 6 numerics, being equal to the practitioner’s billing number, or not being eligible for a specific referral type (e.g., Nurse Practitioner or Midwife). Review and correct the referral number as per the requirements.

This error suggests that the service code being billed is not allowed to be billed in conjunction with a visit code. Review the service code requirements and billing guidelines.

This rejection indicates that the procedure being billed has already been allowed and paid for previously. Check the patient’s billing history to avoid duplicate billing.

This error occurs when the service code being billed is not allowed to be billed alone or as a standalone service. Review the service code requirements and billing guidelines.

This rejection happens when a premium code is billed alone, which is not allowed. Ensure that the premium code is billed in conjunction with the appropriate service code.

This error indicates that the corresponding procedure code associated with the billed service code is either invalid, omitted, or paid at zero. Verify the correct corresponding procedure code and ensure it is included and valid.

This rejection occurs when the service codes being billed together are not allowed to be billed in combination. Review the service code requirements and billing guidelines to ensure compatibility.

This error suggests that the admission date and/or hospital number provided on the claim is invalid. Double-check and correct the admission date and hospital number as per the patient’s records.

This rejection happens when the service being billed overlaps with or is concurrent with another service provided during the same period. Review the billing guidelines and ensure that services are not being duplicated or overlapping.

This error indicates that the number of services billed for a specific service code has exceeded the allowable limit. Check the service code requirements and adjust the number of services accordingly.

This rejection occurs when the minimum service requirements for a specific service code have not been met. Review the service code requirements and ensure that all necessary criteria are fulfilled before billing.

This error suggests that multiple procedures have been billed together, which may or may not be allowed depending on the service codes and billing guidelines. Review the requirements and adjust the billing accordingly.

This rejection indicates that a previous obstetrical service has already been billed or paid for the patient. Check the patient’s billing history and ensure that duplicate billing is not occurring.

This error suggests that a visit by the Most Responsible Physician (MRP) has already been paid for the patient. Coordinate with the MRP and other practitioners involved in the patient’s care to avoid duplicate billing.

This rejection occurs when the referring physician’s number is missing from the claim. Ensure that the referring physician’s number is included and valid.

This error indicates that a referring physician’s number is required for the service code being billed but was not provided. Include the appropriate referring physician’s number on the claim.

This rejection happens when the service code being billed is not allowed to be billed in conjunction with a surgical procedure code. Review the service code requirements and billing guidelines.

This error suggests that more than one modality has been billed, but only one modality is allowed for the service code. Review the service code requirements and billing guidelines.

This error indicates that there is no established patient-physician relationship for the service being billed. Review the billing guidelines and ensure that the service meets the requirements for a valid patient-physician relationship.

This error indicates that there is no established patient-physician relationship for the service being billed. Review the billing guidelines and ensure that the service meets the requirements for a valid patient-physician relationship.

This rejection happens when the modality included in the claim is not allowed for the service code being billed. Verify the service code requirements and include the appropriate modality.

This error suggests that the counselling service being billed is not allowed or not covered. Review the billing guidelines and ensure that the counselling service meets the coverage criteria.

This error indicates that the service date on the claim is before the patient’s eligibility effective date. Ensure that the service date falls within the patient’s eligibility period.

This error occurs when the service date on the claim is after the patient’s eligibility end date. Verify the patient’s eligibility period and ensure the service date falls within it.

Similar to EH1 and EH4, this rejection indicates that the service date is outside the patient’s eligibility period. Double-check the eligibility dates and ensure the service was provided during the covered period.

This error suggests that the patient’s eligibility has been terminated due to their death. Verify the patient’s status and eligibility before submitting the claim.

This rejection occurs when the patient’s health number provided on the claim has not been activated or is invalid. Confirm the correct health number and ensure it is active.

This error indicates that the fee schedule code (FSC) being billed is not valid for a nurse practitioner. Verify the appropriate FSC for nurse practitioners and adjust the claim accordingly.

This rejection happens when the billing for a network has not been approved. Ensure that the network is approved for billing the service before submitting the claim.

This error suggests that the patient is either not rostered or is rostered to another network. Verify the patient’s rostering status and ensure they are properly rostered for the network submitting the claim.

This rejection occurs when the enrolment date provided on the claim does not match the patient’s actual enrolment date. Double-check and correct the enrolment date.

This error indicates that the code submitted for the patient’s eligibility under Ontario Works or the Ontario Disability Support Program is incorrect. Verify and correct the eligibility code.

This rejection happens when the patient is not eligible for the program under which the service is being billed. Confirm the patient’s eligibility and program requirements before submitting the claim.

This error suggests that the enrolment transaction being submitted is not allowed or is invalid. Review the enrolment guidelines and requirements to ensure the transaction is permitted.

This rejection occurs when the service being billed is not intended for enrolment or re-enrolment purposes. Verify the appropriate service codes for enrolment or re-enrolment.

This error indicates that the service date provided on the claim is incorrect in relation to the patient’s enrolment date. Double-check and correct the service date based on the enrolment date.

This rejection suggests that an enrolment restriction has been applied, which may prevent the service from being billed. Verify the enrolment restrictions and ensure compliance with the requirements.

This error occurs when the fee schedule code (FSC) being billed is incorrect for the group type submitting the claim. Ensure the correct FSC is used for the specific group type.

Similar to EH9, this rejection indicates that the patient’s health number provided on the claim has not been activated or is invalid. Confirm the correct health number and ensure it is active.

This error suggests that the code being billed must be submitted alone and cannot be combined with other codes on the same claim. Review the billing guidelines and submit the code separately.

This rejection occurs when the clinic or practitioner submitting the claim is not registered with OHIP. Ensure that the clinic or practitioner is properly registered before submitting claims.

This error indicates that the specialty code provided on the claim is either inactive or not registered for the practitioner on the date of service. Verify the practitioner’s specialty registration and ensure the correct specialty code is used.

This rejection happens when a claim is submitted as a pay patient, but the healthcare provider is registered as opted-in for the date of service. Ensure the correct billing method is used based on the provider’s opt-in/opt-out status.

This error is the opposite of EQ3, where a claim is submitted as pay provider, but the healthcare provider is registered as opted-out for the date of service. Again, ensure the correct billing method is used based on the provider’s opt-in/opt-out status.

This rejection occurs when the laboratory submitting the claim is inactive on the service date. Verify the laboratory’s active status and ensure the claim is submitted for a valid service date.

This error indicates that the referral number or requisitioning healthcare provider number provided on the claim is not registered with the Ministry of Health. Confirm and correct the referral or requisitioning provider number.

This rejection occurs when the group submitting the claim is not registered with the Ministry of Health. Ensure that the group is properly registered before submitting claims.

This error indicates that the group submitting the claim is inactive on the service date. Verify the group’s active status and ensure the claim is submitted for a valid service date.

This rejection happens when the healthcare provider submitting the claim is not registered with the Ministry of Health as an affiliate of the group on the date of service. Ensure that the provider is properly affiliated with the group and registered accordingly.

Similar to EQE, this error occurs when the healthcare provider is not actively registered with the Ministry of Health as an affiliate of the group on the date of service. Verify the provider’s active registration status as an affiliate of the group.

This rejection indicates that the referring laboratory provided on the claim is not registered with the Ministry of Health. Confirm and correct the referring laboratory information.

This error suggests that there is an issue with the contract characteristics associated with the claim. Review the contract details and ensure compliance with the applicable terms and conditions.

1. A new graduate practitioner bills a new patient fee (Q013) when they are not eligible.

2. A physician who is not a new graduate bills the new graduate-new patient fee (Q033).

Ensure the practitioner meets the eligibility criteria for billing the specific new patient fee codes.

This error happens when the master number (MNI) provided does not meet the criteria. Specifically, it occurs when the service code A100 is billed with a specialty code other than 00. Verify the appropriate specialty code and master number combination.

This rejection indicates that the physician is not eligible to claim the fee schedule code (FSC) being billed. It occurs when the service code A100 is billed with a specialty code other than 00 or when the provider has an Emergency Department Alternate Funding arrangement (EDAFA) group number. Confirm the physician’s eligibility and ensure the correct FSC is used.

This error suggests that the service or code being billed is not registered for use. Verify the registration status and ensure compliance with the applicable guidelines.

This rejection occurs when there is an error related to the registration usage on the service date. Review the registration details and ensure proper usage for the service date.

This error indicates that the enrolment type provided on the claim is not eligible for the service being billed. Confirm the appropriate enrolment type and eligibility criteria.

This rejection happens when the practitioner submitting the claim does not meet the necessary criteria for billing the service. Review the practitioner’s qualifications and ensure they meet the criteria for the specific service code.

This error suggests that the referring physician’s number provided on the claim is currently ineligible for making referrals. Verify the referring physician’s eligibility status and use an eligible referring number.

This rejection occurs when the hospital emergency department is part of an alternative funding agreement on the service date. Ensure compliance with the funding agreement and billing guidelines.

This error indicates that the provider or entity submitting the claim is not eligible to bill for the service. Verify the eligibility criteria and ensure compliance.

This rejection happens when a blank health number (HN) is provided on the claim, but the provider or service is not eligible for using a blank HN. Review the eligibility criteria for using a blank HN.

This error occurs when a non-encounter service claim is submitted with a health number (HN) when no HN is required for the fee schedule code (FSC) being billed. Remove the HN from the claim if it is not required for the FSC.

This rejection can occur in two situations:

1. The patient is not on the Health Care Connect (HCC) database, or they are on the database but not marked as complex-vulnerable, which is required for eligibility.

2. The patient is on the HCC database, but their status is not ‘referred to’.

Verify the patient’s status on the HCC database and ensure they meet the eligibility criteria.

This error indicates that the patient was enrolled to the billing physician more than 3 months after the ‘referred to’ date on the HCC database. Ensure the enrolment occurs within the 3-month window from the ‘referred to’ date.

This rejection occurs when the smoking cessation counseling fee (Q042) or the smoking cessation follow-up fee (K039) is billed, but the initial discussion fee (E079) has not been paid within the previous 365 days. Ensure the initial discussion fee is paid before billing the counseling or follow-up fees.

This error indicates that a Physician Assistant (PA) Pilot claim submission includes OHIP insured service fee schedule codes (FSCs) in addition to the PA Tracking FSCs, which is not allowed. Remove the non-PA Tracking FSCs from the claim.

This rejection occurs when a Physician Assistant (PA) Pilot claim submission does not include the solo billing number of the supervising physician in the ‘Refer Physician’ field. Add the supervising physician’s solo billing number to the claim.

his error suggests that the physician and/or referring physician numbers provided on the PA Pilot claim submission are not affiliated with the PA Pilot group number. Ensure the correct billing numbers affiliated with the PA Pilot group are used.

This rejection indicates an error related to the PA registration on the service date. Verify the PA’s registration status and ensure it is valid for the service date.

This error suggests an issue with the PA’s affiliation. Review the PA’s affiliation details and ensure they are correct and up-to-date.

Similar to PA5, this rejection occurs when there is an error with the PA’s affiliation on the service date. Confirm the PA’s affiliation status and ensure it is valid for the service date.

This error indicates that the region code provided on the claim is invalid. Verify and correct the region code.

This rejection occurs when the claim number is less than the service date, which is an invalid combination. Ensure the claim number and service date are correct and in the proper format.

This error suggests that the clinic code provided on the claim is incorrect. Verify and correct the clinic code.

This rejection indicates that the practitioner number provided on the claim is invalid. Confirm and correct the practitioner number.

This error can occur for several reasons related to the specialty code:

– The specialty code is missing or not 2 numerics.

– The specialty code provided is not valid.

– The specialty code is 27, but the provider number is not 599993.

– The specialty code is 90, but the provider number is not 991000.

– The specialty code is 49, 50, 51, 52, 53, 54, 55, 70, or 71, but the healthcare provider number does not begin with 4.

– The specialty code is 56, but the healthcare provider number does not begin with 80 or 81.

– The specialty code is 80 or 81, but the healthcare provider number does not begin with 82.

Verify and correct the specialty code based on the applicable rules.

This rejection occurs when the referral number provided on the claim is invalid. Confirm and correct the referral number.

This error can happen for several reasons related to the patient’s date of birth:

– The date of birth is missing.

– The date of birth is not in the correct format (not 8 numerics).

– The month is not in the range of 01-12.

– The day is outside the acceptable range for the specified month.

Verify and correct the patient’s date of birth in the proper format.

This rejection indicates that the diagnostic code provided on the claim is not acceptable or invalid, likely because it is not numeric. Confirm and correct the diagnostic code.

This error occurs when the payee indicator on the claim is not ‘P’ (Provider) or ‘S’ (Patient). Correct the payee indicator to one of these two values.

This rejection suggests that the admission date or first visit date provided on the claim is invalid. Verify and correct the admission or first visit date.

This error indicates that the diagnostic code provided on the claim is invalid for a chiropractor. Confirm and correct the diagnostic code based on the appropriate codes for chiropractors.

This rejection can occur in two scenarios:

1. The service code is A007, the patient is over 2 years old, and the diagnostic code is ‘916’.

2. The service code is A003, the patient is under 16 years old, and the diagnostic code is ‘917’.

In both cases, the patient’s age does not match the acceptable age range for the specified diagnostic code and service code combination. Review and correct the diagnostic code or service code accordingly.

This error indicates that a diagnostic code is required for the claim but was not provided. Add the appropriate diagnostic code to the claim.

This rejection occurs when the diagnostic code provided on the claim is invalid or incorrect. Verify and correct the diagnostic code.

This error suggests that there may be an issue with the number of services provided on the claim. Review and correct the number of services, if necessary.

This rejection indicates that the hospital number provided on the claim is invalid. Confirm and correct the hospital number.

This error occurs when the in-patient or out-patient indicator provided on the claim is invalid. Verify and correct the in-patient or out-patient indicator.

This rejection happens when the combination of the fee schedule code (FSC) and diagnostic code provided on the claim is not a covered benefit or is not an allowed combination. Review the FSC and diagnostic code requirements and ensure they are compatible and covered.

This error indicates that one or more of the following required fields are missing from the claim header: group number, healthcare provider number, or specialty code. Ensure all required fields are populated correctly.

This rejection can occur for two reasons:

1. The service code provided on the claim is invalid.

2. The service code and healthcare provider type do not match or are incompatible.

Verify and correct the service code and ensure it is valid for the healthcare provider type.

This error suggests that the out-of-province or out-of-country service provided on the claim is invalid or not covered. Review the service details and eligibility criteria for out-of-province or out-of-country services.

This rejection occurs when the input criteria required for sessional billing are not met or are incorrect. Review and ensure compliance with the input criteria for sessional billing.

This error indicates that the number of items or services provided on the claim exceeds the maximum allowed, which is 99. Adjust the claim to include no more than 99 items or services.

This rejection can occur for several reasons related to the fee schedule code (FSC):

– The service code is missing.

– The service code is not in the correct format (ANNNA, where A is alphabetic and NNN is numeric).

– The last character of the service code is not alphabetic (A-C).

Verify and correct the FSC format and ensure it is valid

This error can happen for the following reasons related to the fee billed:

– The fee billed is missing or not 6 numerics.

– The fee billed is not in the range ‘000000’-‘500000’ ($$$$cc).

Confirm and correct the fee billed amount, ensuring it is in the proper format and range.

This rejection occurs when the number of services provided on the claim is invalid or incorrect for one of the following reasons:

– The number of services is missing or not 2 numerics.

– The number of services is not in the range ’01-99′.

Verify and correct the number of services, ensuring it is in the proper format and range.

This error indicates that the fee billed on the claim is not evenly divisible (to the cent) by the number of services provided. Adjust the fee or the number of services to ensure the fee is divisible by the number of services.

This rejection occurs when the service date provided on the claim is before the initial visit date for physiotherapy services. Ensure the service date is on or after the initial visit date for physiotherapy.

This error suggests that the location code provided on the claim is invalid. It must be either blank or four numerics, and if present, it must be a valid code based on the MOHLTC Residency Code Manual. Verify and correct the location code accordingly.

This rejection indicates that the fee schedule code (FSC) provided on the claim is invalid for magnetic tape or disk submissions. Confirm and correct the FSC for magnetic tape or disk submissions.

This error occurs when the service location indicator (SLI) provided on the claim for a hospital diagnostic service billing from a participating hospital physician or group is not one of the five valid SLI codes: HDS, HED, HIP, HOP, or HRP. Verify and correct the SLI code.

This rejection indicates that the referring laboratory number provided on the claim does not start with 5 (5###), which is the required format. Confirm and correct the referring laboratory number to start with 5.

This error suggests that the service location indicator (SLI) is missing from the claim. Add the appropriate SLI code to the claim.

This rejection occurs when one of the SLI codes HDS, HED, HIP, HOP, or HRP is included with a diagnostic service billing, but a master number is not provided. Add the required master number to the claim.

This error indicates that the SLI code HIP is included with a diagnostic service billing, but an admission date is not provided. Add the admission date to the claim.

This rejection happens when the SLI code HIP is included with a diagnostic service billing, but both the master number and admission date are missing. Provide both the master number and admission date on the claim.

This error occurs when a diagnostic service is billed with a master number and admission date, but the SLI code provided is not HIP, which is required for this combination. Verify and correct the SLI code to HIP if billing a diagnostic service with a master number and admission date.

This rejection indicates that the service date provided on the claim is invalid for the specified service location indicator (SLI). Review the service date and ensure it is valid for the SLI code used.

This error suggests that the date of service provided on the claim is greater than (more recent than) the file or batch creation date. Ensure the date of service is correct and does not exceed the file or batch creation date.

This rejection occurs when the dental master number provided on the claim is invalid. Verify and correct the dental master number.

This error indicates that the OTN (Ontario Telemedicine Network) service location indicator (SLI) provided on the claim is no longer active or valid. Confirm the current valid SLI code for OTN services.

This rejection suggests that the date of service provided on the claim for a preventive care service is incorrect. Verify and correct the date of service for the preventive care service.

This error can occur for several reasons related to the service date:

– The date of service is missing or not 8 numerics.

– The month is not in the range of 01-12.

– The day is outside the acceptable range for the specified month.

– The date of service is greater than the Ministry of Health system run date.

Confirm and correct the service date, ensuring it is in the proper format and within the valid range.

This rejection indicates that the claim being submitted is stale-dated, meaning it is too old or past the acceptable submission deadline. Review the claim submission guidelines and ensure the claim is submitted within the required timeframe.

Similar to VJ7, this error suggests that the claim encounter being submitted is stale-dated or past the acceptable submission deadline. Verify the claim encounter submission guidelines and ensure it is submitted within the required timeframe.

This rejection occurs when a technical fee is billed, but the service location indicator (SLI) is missing or not provided. Add the appropriate SLI code to the claim when billing a technical fee.

This error indicates that the SEAMO (Southeastern Ontario Academic Medical Organization) provider code provided on the claim is invalid. Verify and correct the SEAMO provider code.

This rejection suggests that the venue type provided on the claim is invalid. Confirm and correct the venue type.

This error occurs when the clinic number provided on the claim is invalid. Verify and correct the clinic number.

This rejection indicates that the healthcare item provided on the claim is invalid. Confirm and correct the healthcare item.

Similar to V29, this error suggests that the in-patient or out-patient indicator provided on the claim is invalid. Verify and correct the in-patient or out-patient indicator.

This rejection occurs when the format of the healthcare item code provided on the claim is invalid. Review and correct the format of the healthcare item code.

This error indicates that a virtual tech code is required for the service being billed but was not provided. Add the appropriate virtual tech code to the claim.

This rejection suggests that only one virtual tech code (VTC) is allowed on the claim, but multiple VTCs were provided. Remove the additional VTCs and leave only one.

This error occurs when the OHIP number provided on the claim is not registered with the ministry for the specified health number. Verify and correct the OHIP number or health number combination.

This rejection happens when a non-encounter service claim is submitted with a health number (HN), but no HN is required for the fee schedule code (FSC) being billed. Remove the HN from the claim if it is not required for the FSC.

This error indicates that Claim Header-2 is present on an MRI claim submitted with a health number in Claim Header-1, which is not allowed. Remove either Claim Header-2 or the health number from the claim.

This rejection occurs when the health number provided on the claim is missing or invalid. Verify and correct the health number.

This error suggests that the health number is missing from the claim when it is required (for payment programs HCP or WCB). Add the health number to the claim.

This rejection indicates that the payment program provided on the claim is missing or is not equal to HCP, RMB, or WCB, which are the valid payment program codes. Verify and correct the payment program code.

This error occurs when the version code provided on the claim is invalid. Confirm and correct the version code.

This rejection suggests that an OHIP number is required for the service date provided on the claim, but it was not included. Add the OHIP number to the claim.

This error indicates that multiple service dates are present on the claim, which is not allowed. Ensure only one service date is provided on the claim.

This rejection occurs when both a health number and an OHIP number are provided on the same claim, which is not allowed. Remove either the health number or the OHIP number from the claim.

This error suggests that the date of birth provided on the claim does not match the health number submitted. Verify and correct either the date of birth or the health number to ensure they match.

This rejection indicates that the health number provided on the claim is not registered with the ministry. Confirm and correct the health number.

This error occurs when the Interprofessional Comprehensive Health Services Collaborative (ICHSC) number provided on the claim is not approved for billing on the specified date. Verify the ICHSC number’s approval status for the billing date.

This rejection indicates that the ICHSC is not licensed or grandfathered to bill the fee schedule code (FSC) on the specified date. Ensure the ICHSC is properly licensed or grandfathered for the FSC being billed.

This error suggests that the insured services being billed are excluded from ICHSC billings. Review the ICHSC billing guidelines and ensure the services are eligible for billing.

This rejection occurs when the provider submitting the claim is not approved to bill the ICHSC fee on the specified date. Verify the provider’s approval status for billing the ICHSC fee.

This error indicates that the ICHSC practitioner with the number 991000 is not allowed to bill insured services. Ensure the appropriate practitioner number is used for billing insured services.

This rejection suggests that a referring physician number is required for the ICHSC fee being billed, but it was not provided. Add the referring physician number to the claim.

This error occurs when a service code starting with ‘I’ is billed by an entity other than an ICHSC, as these codes are exclusive to ICHSCs. Ensure the appropriate service codes are used for non-ICHSC billings.

This rejection indicates that a mobile site number is required for the service being billed, but it was not provided. Add the appropriate mobile site number to the claim.

This error suggests that the Health Service Number (HSN) is missing from the claim. Provide the HSN for the service being billed.

This rejection occurs when the Health Service Number (HSN) provided on the claim is invalid. Verify and correct the HSN.

This error indicates that the province code provided on the claim is invalid or missing. Confirm and correct the province code.

This rejection suggests that the service being billed is excluded from the Reciprocal Medical Billing Services (RMBS). Review the RMBS guidelines and ensure the service is eligible for billing.

This error occurs when the provincial code provided on the claim is invalid for RMBS. The provincial code should be ‘ON’ (Ontario) or ‘PQ’ (Quebec), except for Outaouais claims. Verify and correct the provincial code.

This rejection indicates that the provider submitting the claim is invalid for RMBS. Ensure the provider is eligible and registered for RMBS billing.

This error suggests that the payment type provided on the claim is invalid for RMBS. Confirm and correct the payment type for RMBS billing.

This rejection occurs when the referral number provided on the claim is invalid for RMBS. Verify and correct the referral number.

This error indicates that Claim Header 2 is missing from the claim for RMBS billing. Add Claim Header 2 to the claim.

This rejection can occur for two reasons:

1. The patient’s last name is missing from the claim.

2. The patient’s last name is not alphabetic (contains characters other than A-Z), or the first field position is blank.

Provide the patient’s last name in the correct format (alphabetic characters only).

Similar to V10, this error suggests that the patient’s first name is missing, not alphabetic (contains characters other than A-Z), or the first field position is blank. Provide the patient’s first name in the correct format (alphabetic characters only).

This rejection occurs when the patient’s sex provided on the claim is not ‘1’ (male) or ‘2’ (female), which are the only valid values. Correct the patient’s sex to either ‘1’ or ‘2’.

This error indicates that the provider or entity submitting the claim is not registered for telemedicine services. Ensure proper registration for telemedicine billing.

This rejection suggests that the telemedicine premium or tracking code is missing from the claim. Add the appropriate telemedicine premium or tracking code to the claim.

This error occurs when a telemedicine billing is submitted with a telemedicine tracking code, but the service location indicator (SLI) code is not ‘OTN’ (Ontario Telemedicine Network) or is not present. Verify and correct the SLI code for telemedicine billing.

This rejection indicates that a duplicate telemedicine claim has been submitted for the same patient. Remove or correct the duplicate claim.

This error suggests that the service being billed is not eligible for missed, canceled, or abandoned appointments. Review the billing guidelines for missed/canceled/abandoned appointments.

This rejection occurs when the service being billed is not payable under the telemedicine program. Ensure the service is eligible for telemedicine billing.

This error indicates that a non-telemedicine claim has already been paid for the same patient, preventing the telemedicine claim from being paid. Coordinate billing to avoid duplicate claims.

This rejection suggests that a telemedicine claim has already been paid for the same patient, preventing another telemedicine claim from being paid. Avoid duplicate telemedicine claims for the same patient.

This error occurs when the registration for telemedicine services is not in effect on the service date provided on the claim. Verify the registration dates and ensure they cover the service date.

This rejection indicates that the dental service being billed is not eligible for telemedicine billing. Review the telemedicine guidelines for eligible services.

This error suggests that the service being billed is not eligible for store-forward telemedicine services. Ensure compliance with store-forward eligibility criteria.

This rejection occurs when the service being billed is invalid for Workers’ Compensation Board (WCB) claims. Verify the service eligibility for WCB billing.