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Ontario Health Insurance Plan

OHIP Bulletins


INFOBulletin

Keeping Health Care Providers informed of payment, policy or program changes

Primary Health Care Services InfoBulletins

To: Eligible Patient Enrolment Model Physicians

Published by: Negotiations Branch

Date Issued: May 30, 2017

Bulletin Number: 11176

Re:Per Patient De-Rostering Codes - EH2 Error Update

Posted Electronically Only

PDF Version Portable Document Format | 130 kb


Further to INFOBulletin #11170 issued March 7, 2017, the Ministry has resolved the issue of patient de-rostering claims rejecting due to invalid health number version codes (i.e. EH2). Per Patient De-Rostering (PPDR) Q codes submitted with an invalid version code will no longer reject to the physician's Claims Error Report.

Effective May 23, 2017, PPDR Q Codes submitted with an invalid version code will be processed and paid at $0 with explanatory code '30 - Not a benefit of OHIP' and will report on the monthly Remittance Advice (RA). No further action is required for the claim.

Patient enrolments will be ended in the system as of the service date of the claim. Physicians can verify the patient's enrolment has ended by reviewing the Roster and Capitation Payment Reconciliation Report.

NEW Billing Rules for PPDR Q Codes - Q401A, Q402A and Q403A

  • PPDR Q codes must be billed as the only item on the claim. These claims will pay $0 with explanatory code '30 - Not a benefit of OHIP' and will report on the monthly RA
  • PPDR Q codes submitted on the same claim with other fee schedule codes will reject to the physician's Claims Error Report with error code 'EP7 - Code must be billed alone'

PPDR Q codes will continue to be processed in adherence with all other ministry payment rules. If your patient's end date does not appear on the Roster and Capitation Payment Reconciliation Report, verify your Claims Error Report and make any corrections needed before resubmitting.

For any other inquiries regarding the patient de-rostering process please contact the Service Support Contact Centre:

1-800-262-6524

SSContactCentre.MOH@ontario.ca


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