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

Workplace Safety and Insurance Board
(formerly the Workers' Compensation Board (WCB))

VW1
  • This service is not valid for WCB.

    Independent Health Facilities (IHF)

    A I 4
  • Records show this service has been rendered by another practitioner, group or IHF.
    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.

    Reciprocal Medical Billing (RMB)

    R01
  • Missing HSN
    R02
  • Invalid HSN
    R03
  • Province code is missing / not a valid province code.
    R04
  • Fee schedule code excluded from RMB.
    R05
  • 'ON' (Ontario province code) not valid for RMB.
    R06
  • Wrong health care provider for RMB (begins with 3, 4, 8 or 9).
    R07
  • Invalid pay-type for RMB (must be 'P').
    R08
  • Invalid referral number (applies to Outaouais Region, Quebec only).
     
  • Not 7 numerics.
    R09
  • Claim Header-2 is missing and the payment program is RMB.

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