OHIP billing is an essential aspect of healthcare practice management in Ontario, and even small errors can lead to rejections or delayed payments. Errors in billing submission to OHIP (Ontario Health Insurance Plan) are more common than you might think, and understanding these mistakes can save physicians both time and money. In this blog, we’ll explore the most common OHIP billing errors and provide you with clear steps on how to fix them.
1. ARF – Invalid Referral Number
The ARF error indicates that the referral number provided is invalid. This is usually due to an incorrect or missing billing number for the referring physicians.
To correct an ARF error:
- Go into the claim that has been flagged with the ARF error.
- Input the correct referring physician’s billing number.
- Resubmit the claim.
By ensuring that the referral details are accurate and complete, you reduce the chance of this common error. Regularly updating your records with the correct referring physician details is key to avoiding ARG errors.
2. EH2 – Invalid Version Code
The EH2 error occurs when the healthcare version code provided for the patient is invalid. This can happen if the patient has recently received a new card and the version code on file is outdated.
To rectify an EH2 error:
- Update the patient’s demographic information with the correct version code.
- Go into the claim with the EH2 error.
- Resubmit the claim.
It’s a good idea to regularly verify the patient’s health card information to avoid this error. Encouraging patients to notify you of any changes to their health card details will also help reduce occurrences.
3. VH9 – Health Number Not Registered with MOH
A VH9 error means the health number submitted is not registered with the Ministry of Health (MOH). This typically happens when a patient is a newborn and has not yet received their updated health number.
To resolve a VH9 error:
- Wait until the patient receives their new health card.
- Update the patient demographic with the correct healthcare number.
- Resubmit the claim once the information is verified.
Ensure the patients are aware of the need to provide information as soon as they receive a new health card.
4. D3 – Service Fee Code Not Allowed in Addition to Visit Fee
The D3 error occurs when a service fee code is billed alongside a visit fee code that does not allow for both. This is usually due to incorrect coding combinations. For example, when a physician submits a claim for general assessment A007 and bills for a minor procedure, such as the excision of a skin lesion Z173 during the same visit, the physician will receive a D3 error for the claim. The OHIP rules state that certain procedure codes cannot be billed together with a general assessment on the same day for the same patient.
To fix a D3 error:
- Review the billing codes submitted on the claim.
- Identify the service fee code that is not allowed in addition to the visit fee.
- Remove the disallowed service fee code or change it to an appropriate one and resubmit the claim.
Refer to OHIP’s schedule of benefits for allowable combinations of service and visit fee codes to avoid this error.
5. M1 – Maximum Fee Allowed or Maximum Number of Services
The M1 error occurs when the billing exceeds the maximum fee allowed or the maximum number of services that can be claimed. For instance, the K030 Diabetes Management code is limited to being billed a maximum of four times per year. If it is billed more than this, an M1 error will be triggered.
To rectify an M1 error:
- Identify the code that exceeds the maximum limit.
- Remove the incorrect code.
- Instead, bill with an appropriate code such as A007 and resubmit the claim.
Regularly reviewing the OHIP fee schedule and guidelines for maximums can help prevent this type of error. Make sure to use the correct codes and stay within the allowable limits for services provided.
6. VH1 – Healthcare Number is Invalid
The VH1 error signifies that the healthcare number submitted has a typo or is incorrect. This can happen if a digit is missing or out of order.
To correct a VH1 error:
- Contact the patient to verify the correct healthcare number.
- Update the patient’s demographics with the accurate healthcare number.
- Resubmit the claim.
Verifying the patient’s information at every visit can help avoid this error. Make sure that your front desk staff are diligent in checking and entering health card numbers correctly.
7. V22 – Incorrect Diagnostic Code
A V22 error indicates that the diagnostic code used in the claim is incorrect or does not match the service provided.
To fix a V22 error:
- Refer to the OHIP list of diagnostic codes to find the correct code.
- Update the diagnostic code in the claim and resubmit it.
Having the Ministry’s list of diagnostic codes handy can prevent this error from occurring.
8. V98 – Wrong Date of Service for Preventive Care Codes
The V98 error occurs when preventive care codes are billed with an incorrect date. For certain preventive care services, OHIP requires that the service date be March 31st for year-end submissions.
To resolve a V98 error:
- Correct the date of service on the claim to match the required date (e.g., March 31st).
- Resubmit the claim.
Ensuring that you know the specific date requirements for preventive care codes is essential to avoid this mistake.
By understanding these common OHIP billing errors and the steps to correct them, you can reduce claim rejections and ensure smoother operations for your practice. Remember, time is of the essence – errors must be corrected within three months to avoid a stale claim process. Regular staff training and a solid understanding of the OHIP billing rules can significantly reduce the frequency of these errors.
Have questions? Contact us today at info@oscarprodesk.ca.