Claims Submission Ontario Health Insurance Program
Resource Manual for Physicians
 
4.5   Reports (Continued)

The Error Code is a three-character alpha/numeric code. The first character is an alpha and denotes the type of reject as follows :

V Validity Error (applies to HCP/WCB/RMB payment programs);
A Assessment Error (applies to HCP/WCB/RMB payment programs);
E Eligibility Error (applies to HCP/WCB/RMB payment programs);
R Reciprocal Medical Billing (RMB) Specific Errors;

A rejected claims item may be internally re-routed to the Error Report by the ministry and will include an explanatory code message. The explanatory code message is generated to provide more detailed information as to why the claim is being returned. Explanatory code messages appear directly below the related claim item (refer to section - Explanatory Codes).

Rejected claims shown on the Error Reports are returned during the process month. The corrected information should be resubmitted immediately. If the resubmitted information is received prior to the 18th of the same month, the claim can be processed for payment in the same billing cycle. Claims must be resubmitted within six months of the date of service to avoid it being rejected as a stale dated claim.

Claims Error Reports should be retained on file in your office to assist in monthly payment reconciliations. If claims are not approved for payment on your monthly Remittance Advice Report, then check your Error Report for that month to determine if the claim was rejected and needs to be submitted again.

An EDT Claims Error Report is usually sent within 48 hours of claims file submission. If claims are uploaded on a weekend, holiday or at month end, the Error Report is delivered on the next claims processing day.

Diskette submission of claims will result in a paper Error Report that will be mailed to you. The billing software determines the layout of the report, but all reports contain the same information.

Remittance Advice Report

A Remittance Advice Report (RA) is a monthly statement of approved claims. It is issued at the same time as your payment.

If you submit via EDT you will receive your RA between the 5th and 7th of the month. If the claims are submitted on diskette, you will receive your RA between the 12th and 15th.

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