Error codes and what they mean:
Level 1 Error Codes are errors returned by the MOH that can typically be corrected and resubmitted. These errors mean you have the opportunity to make the necessary changes to the claim and resubmit it for processing.
Level 2 Error Codes are errors identified and assessed by MOH. These errors appear on your Remittance Advice (RA). To request payment on these claims, you must submit a Request for payment by submitting an RAI with your documentation.
Error 35 (Level 1)
This error means payment has already been issued for this patient, date of service, and billing number. It may occur if a duplicate claim was submitted or if another claim with different service codes was already paid for the same date. This error cannot be disputed unless you can confirm that you were not paid on a previous Remittance Advice.
Error EH2 (Level 1)
Invalid Health Card: The health card used for the date of service is no longer valid and has a new version code. Contact the patient for their updated version code or contact Agent+ if you are signed up for the MOH PIN service and are on an Assisted or Full Service tier.
Error code 55/57 (Level 2)
Code 55: Shows a deduction or adjustment from a previous payment.
Code 57: Shows the corresponding payment adjustment for the previous account. These two codes are usually listed together, one after the other.
Special visit premiums (SVP’s) are not payable for:
- Hospital or long-term care home rounds or elective admissions.
- Visits to facilities (other than hospitals or long-term care homes) that are open to diagnose or treat patients.
- Visits to non-referred or transferred obstetrical patients.
- Patients seen without an appointment while the physician is already in the office, before, during, or after office hours.
- Visits where a critical care team fee or per diem fee is payable
- Emergency Department (ED) visits where an “H” prefix code is payable, except for the premiums listed in Special Visit Premium Table V for ED physicians called in when they are not scheduled to work and are not already at the hospital.
- Services provided in conjunction with any sleep study listed in the Sleep Studies section of the Schedule.