Claims Submission Ontario Health Insurance Program
Resource Manual for Physicians
 
4.13   Explanatory Codes

Eligibility

EA Service date is not within an eligible period - services provided on or after the 20th of this month will not be paid unless eligibility status changes.
EV Check health card for current version code (applicable for service dates prior to February 1/1993).
EF Incorrect version code - services provided on or after the 20th of this month will not be paid unless the current version code is provided.
E1 Service date prior to start of eligibility.
E2 Incorrect version code for service date.
E4 Service date after the eligibility termination date.
E5 Service date not within an eligible period.
GF Coverage lapsed - bill patient for future claims.
J3 Approved for stale dated processing.
J7 Claim submitted six months after service date.

General

30 Service is not a benefit of OHIP.
32 OHIP records show service(s) on this day claimed previously.
35 OHIP records show this service rendered has been claimed previously (used on Pay Practitioner duplicate claims).
36 OHIP records show service has been rendered by another Practitioner, Group, Lab.
37 Effective April 1, 1993 the listed benefit for this code is 0 LMS units.
40 Service allowed only once for same patient.
48 Paid as submitted - clinical records may be requested for verification purposes.
49 Paid according to the average fee for this service. Independent consideration will be given if clinical records / operative reports are presented.
50 Paid in accordance with the Schedule of Benefits.
51 Fee Schedule Code changed in accordance with Schedule of Benefits.
52 Fee-for-service assessed by medical consultant.

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