Ontario Health Insurance Plan (OHIP) billing can be a complex process, with various rejection codes indicating why claims fail to process successfully. Understanding these codes is essential for healthcare providers to address issues and improve their billing accuracy. Below, we categorize the most common OHIP billing rejection codes and provide insights into what they mean. In a future post, we will discuss strategies to prevent these errors and how RexBill from RexEMR ensures 99% billing accuracy
Eligibility and Registration Issues
Codes: EH1, EH5, EH6, EQ1, EQ2, etc.
These errors arise from problems related to eligibility periods, active registrations, or valid provider numbers. Examples include:
- Missing or inactive health numbers (HN).
- Ineligible program enrollment.
- Expired practitioner registrations.
Claim Submission Issues
Codes: A3F, A34, V28, V40, etc.
These errors point to submission problems, such as:
- Invalid service codes.
- Incorrect specialty codes.
- Missing referral numbers.
- Data formatting errors.
Referral and Physician Issues
Codes: AC4, ARP, EQF, ERF, etc.
These errors often relate to referring physicians or specialists. Typical problems include:
- Incorrect referring physician’s number.
- Ineligibility or specialty mismatches of the referring practitioner.
Service and Billing Inconsistencies
Codes: A3I, A3L, AMR, AM1, etc.
These errors involve discrepancies in service or billing details, such as:
- Exceeding the maximum allowable services.
- Failing to meet specific service requirements.
- Invalid billing combinations (e.g., duplicate procedure codes).
Patient and Service Code Mismatches
Codes: V16, V17, V19, etc.
Errors in this category stem from mismatches between patient details and service codes. Examples include:
- Using diagnostic codes that are invalid or unaccepted.
- Incorrect patient information, such as age or gender.
Telemedicine and Virtual Service Errors
Codes: ET1, TM1, TM5, etc.
With the rise of telemedicine, these errors are becoming more common. They typically include:
- Issues with telemedicine registration.
- Duplicate claims for virtual services.
- Incorrect telemedicine service codes.
Regional and Administrative Errors
Codes: V02, V10, V12, V14, etc.
These errors involve regional or administrative issues, such as:
- Invalid patient details (e.g., names or address information).
- Regional coding inconsistencies.
In our upcoming blog post, we will explore practical steps to avoid or address these errors and highlight how RexBill’s advanced AI-driven tools in RexEMR streamline billing processes to minimize rejections. With its sophisticated checks and automated corrections, RexBill achieves an industry-leading 99% accuracy, saving time and enhancing revenue for healthcare providers. Stay tuned!
