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Ontario Health Insurance Plan

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Physician Services InfoBulletins

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

To: Physician Services

Published by:Claims Service Branch, Ministry of Health and Long-Term Care

Date Issued: October 3, 2017

Bulletin Number: 4700

Re: A3H and New Error Code A3I - Number of Services Exceeds Maximum Services

Posted Electronically Only

PDF Version Portable Document Format | 1 Mb


Effective October 3, 2017 the ministry has implemented changes on how claims are assessed when the number of services billed is greater than the maximum services listed on the Fee Schedule Master as follows:

A3H - MAX NO SER FSM
Previously, claims resulting in an A3H error code are manually assessed. Claims will now be directed to providers’ error reports which may result in an increased volume of rejected claims with an A3H error code.

NEW:
A3I – XRAY CODE – MAX NO SER FSM
Claims submitted that meet the following two conditions: the number of services is greater than the daily limit listed on the Fee Schedule Master and contain an X-ray Fee Schedule Code will receive the newly assigned A3I error code and will be manually reviewed.

Changes apply to all claims submitted for assessment on or after the October 3, 2017 implementation date regardless of the date of service.

For either circumstance above, claims appearing on the provider error report with an A3H or A3I error code, resubmit with the manual review indicator and provide supporting documentation / justification for the additional services or adjust the number of services to the allowable amount.

For any inquiries please contact the Service Support Contact Centre: 1-800-262-6524 or SSContactCentre.MOH@ontario.ca



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