Ontario Health Insurance Plan

INFOBulletin

Expired and Expiring Health Cards During COVID-19

Most expired and expiring health cards remain valid until further notice


To: All Providers
Category: Physician Services
Written by: Claims Services Branch, Ontario Health Insurance Plan Division
Date issued: November 25, 2020
Bulletin Number: 201107


Further to INFOBulletin 4749, in response to COVID-19, most expired and expiring health cards (including red and white health cards) remain valid at this time and can continue to be used for accessing insured health services until further notice. In the case of expired health cards, only the most current version code will be accepted, and no provision has been made for incorrect version codes.

Red and white cards can continue to be used for insured health services as long as they remain valid.

Physician funding for services provided to uninsured patients is intended to facilitate payments for the following services:

  • medically necessary services provided in the hospital to patients who are not insured under OHIP or another provincial plan or private insurance; and,
  • limited medically necessary services provided by physicians in the community as outlined in INFOBulletin 4749.

In all cases providers should follow existing health card validation services to determine health card validity. If a health care provider cannot reasonably obtain the health card information from the patient or from existing records, the ministry offers an escalation process to provide health numbers and version codes directly to providers. The 24x7 ServiceOntario Help Desk (1-866-532-3161) offers providers accelerated release of health numbers/version codes, such that claims can be submitted to OHIP per the usual billing process. If by using the ministry’s health card validation mechanisms it is determined that a patient’s health card is invalid:

  • Services provided in the hospital may be claimed to the ministry on the spreadsheet provided to hospitals for services provided to uninsured patients.
  • Services provided in the community may not be claimed to the ministry and providers should use existing processes for expired or invalid health cards in these scenarios, as outlined in this INFOBulletin.

OHIP claim submissions are not accepted for invalid cards, whether or not they are expired. Invalid card categories include Lost, Stolen, Damaged or Voided. Individuals with an invalid health card should contact the ServiceOntario INFOline at 1-800-268-1154 or visit their local ServiceOntario centre.

Health Card Validation

As usual, providers should ask for an individual’s most recent health card and validate it each time the patient visits. Validation will help to reduce the number of claims that are rejected for any reason, including patient ineligibility.

If an expired health card passes validation, the card should be accepted and standard OHIP billing procedures should be followed. A card that passes validation would receive a response code between 50-55 from the ministry’s Health Card Validation systems.

If a health card does not pass validation, health care providers should take the following steps:

  • Check for keying errors
  • Confirm the health number and version code
  • Ask if the cardholder has another health card
  • Ask the cardholder to contact ServiceOntario to update their health card registration

If a claim was previously rejected due to an invalid version code or health card eligibility issue, the provider can resubmit the claim once the patient presents with a new valid health card and version code.

Further information regarding Health Card Validation can be found in the Health Card Validation Reference Manual.

Valid Health Card Validation Response Codes

The chart below from the Health Card Validation Reference Manual details response codes indicating if a health card is valid and can be used to submit claims for OHIP-insured services to the ministry. For example, a response code of 53 indicates that the card is expired, but valid to access insured services.

Response Code

Descriptive Text

Recommended Action

50/51

Health card passed validation

You will receive payment for billable services rendered on this day subject to adjudication by the ministry.

52

Health card passed validation; Cardholder did not respond to notice to register

You will receive payment for billable services rendered on this day subject to adjudication by the ministry.

53

Health card passed validation; card is expired

You will receive payment for billable services rendered on this day subject to adjudication by the ministry.

54

Health card passed validation; card is future dated

You will receive payment for billable services rendered on this day subject to adjudication by the ministry.

55

Health card passed validation; cardholder required to update address with ministry

You will receive payment for billable services rendered on this day subject to adjudication by the ministry.

Invalid Health Card Validation Response Codes

The chart below details common response codes indicating a health card is not valid and cannot be used for OHIP claim submissions.

Response Code

Descriptive Text

Recommended Action

05

The Health Number submitted is not 10 numeric digits.

No payment for services, bill the cardholder directly.

10

The Health Number submitted does not exist on the ministry’s system

No payment for services, bill the cardholder directly.

20

Eligibility does not exist for this Health Number

No payment for services, bill the cardholder directly.

25

Unknown health card

No payment for services, bill the cardholder directly.

65

Invalid version code

No payment for services on this Health Number and Version Code combination.
Ask the cardholder to contact the local ServiceOntario office.

70

Health card reported stolen

No payment for services on this Health Number and Version Code combination.
Ask the cardholder to contact the local ServiceOntario office.

75

Health card cancelled or voided

No payment for services on this Health Number and Version Code combination.
Ask the cardholder to contact the local ServiceOntario office.

80

Health card reported damaged

No payment for services on this Health Number and Version Code combination.
Ask the cardholder to contact the local ServiceOntario office.

83

Health card reported lost

No payment for services on this Health Number and Version Code combination.
Ask the cardholder to contact the local ServiceOntario office.

For a complete list of response codes, please see the Health Card Validation Reference Manual.

Keywords/Tags

COVID-19; health card; OHIP card; health card validation; HCV; eligibility

Contact Information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.

Find INFOBulletins online on the Ministry of Health website.

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