Claims Submission Ontario Health Insurance Program
Resource Manual for Physicians
 
4.11   Rejection Conditions

General

AC4
  • A valid referring / requisitioning health care provider number must be present for this service code.
     
  • Referring number is 722900-744292 (Nurse Practitioner) and the billing provider is not a lab (5000 series) and the FSC's are not on the following table :
    L005 L018 L030 L031 L040 L045 L053
    L055 L067 L073 L075 L085 L093 L107
    L111 L117 L139 L148 L157 L181 L191
    L194 L204 L208 L215 L221 L222 L223
    L226 L243 L252 L253 L254 L257 L306
    L309 L310 L311 L315 L318 L319 L321
    L324 L329 L330 L332 L341 L345 L372
    L377 L393 L395 L396 L397 L398 L399
    L417 L418 L419 L445 L452 L462 L481
    L482 L490 L493 L500 L544 L605 L606
    L622 L624 L625 L626 L627 L628 L629
    L630 L631 L634 L636 L637 L638 L640
    L641 L643 L650 L651 L652 L653 L654
    L655 L656 L667 L668 L679 L683 L691
    L700 L710 L713 L716 L718 L719 L733
    L800 L808 L812 L815 L817 L842  

     
  • acceptable codes for cardiology services for Nurse Practitioner referrals (others will reject) :   G310, G313, G700.
    ADM
  • Emergency equivalent / other visits.
    AH8
  • In-patient admission date and / or facility number are missing and are required for this service code.
    AH9
  • In-patient diagnostic service is not allowed with a hospital assessment.
    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.
    A34
  • Multiple duplicate claims.
    A4D
  • Invalid specialty for this service code.
    EH1
  • Service date is prior to eligibility start date.
    EH2
  • Version code does not match health number version code for service date.

    PREVIOUS PAGE 4 - 17 NEXT PAGE