What does OHIP error code EQK mean?

EQK means fee schedule code A100 was billed with a specialty code other than 00. That single circumstance is the whole ministry condition.

Can I resubmit A100 under a different specialty code?

Only if the specialty code on the original claim was recorded incorrectly. If it accurately described the provider, A100 was not the right listing, and changing the specialty code to pass the edit would make the claim inaccurate.

What is the difference between EQK and EQL?

Both are triggered by A100 billed with a specialty code other than 00. EQK reports that the master number does not meet criteria, while EQL reports that the physician is not eligible to claim the code and also covers providers with an Emergency Department Alternate Funding arrangement group number.

Why did a block of claims reject with EQK at once?

Because the specialty code is stored on the provider record rather than entered per claim. If it is wrong, it applies to everything that provider submitted until the record is corrected.

OHIP error report

EQK

Provider registration and referrals

OHIP error code EQK: master number does not meet criteria on an a100 claim

EQK means fee schedule code A100 was billed with a specialty code other than 00. The ministry condition names that single circumstance.

Ministry wording: Master number (MNI) does not meet criteria. Most often affects All specialist practices.

You already know EQK. A single rejection is rarely the whole pile. Specialists we work with recover $10,000 to $100,000+ from rejected and unpaid claims, then average a 20–40% revenue increase within 90 days.

Each minute looking this up is about $5 of clinic time.

1Why it fires
2What it costs
3What you can recover

See what you can recover

EQK at a glance

EQK is an E-series registration edit, rejected on the Claims Error Report before adjudication. The ministry condition is one sentence: A100 billed with a specialty code other than 00.

That makes EQK unusually narrow. Most registration codes describe a class of problem. EQK describes one listing and one field. If the claim is not A100, EQK cannot fire, and if the specialty code on it is 00, EQK cannot fire either.

Specialty code 00 is Family Practice and Practice In General, per the ministry specialty code list. So A100 is a family practice listing, and no specialist registration can carry it. For a specialist practice that makes EQK a misselection rather than a judgement call: the claim was never available under that registration, so there is no version of it that pays. The Schedule of Benefits is the place to confirm what A100 covers, because the rejection condition says nothing about the service.

EQK also has a near twin. EQL covers A100 billed with a specialty code other than 00 as well, and adds a second trigger for a provider with an Emergency Department Alternate Funding arrangement group number. The two codes share a trigger and report different reasons, so the first job on receiving either is to read which one arrived.

Why it fires

Fee schedule code A100 was submitted with a specialty code other than 00.
The specialty code on the claim header or the provider record is not the one the listing requires.
A100 was selected from a template or a favourites list by a provider whose registration does not support it.
A group or locum arrangement submits under a specialty code different from the one assumed when the template was built.

The mechanism is a mismatch between a listing and a registration, so it is usually a configuration or a selection problem rather than a clinical one. The service may well have happened. The claim is asserting it under a specialty code the listing does not accept.

Template and favourites selection is the most common route, and it is the one that reaches specialist practices. Where A100 sits in a shared list of frequently used codes in a mixed group, any provider can select it, including every physician whose registration is not family practice. A single-specialty practice that has never had a family physician on its roster has little reason to meet this code at all.

Locum and cross-cover arrangements produce the same result for a different reason. The specialty code travels with the registration rather than with the location, so a claim submitted correctly by one physician can be invalid when submitted by their cover.

Because EQK and EQL overlap, resist drawing a conclusion from the trigger alone. EQK reports the master number criteria and EQL reports practitioner eligibility, so the code that arrived tells you which test the ministry applied, and that is the thing to act on.

What it costs

The claim is rejected in full and the fee for that service is unpaid until a valid claim is submitted. Where the specialty code is correct, the listing itself may be the wrong claim.

Nothing part-pays. The claim did not reach adjudication, so the entire fee for the service is outstanding.

EQK carries a second kind of cost that most rejection codes do not. Where the specialty code is right, the question becomes whether A100 was ever the correct listing for this service and this provider, and that is a billing-accuracy question rather than a correction.

The three-month submission window from ministry INFOBulletin 230402 applies to services on or after 1 April 2023. Where the service was real and a different listing applies, the window governs how long the practice has to submit the accurate claim rather than to resubmit this one.

Fee codes this most often affects

A100 · See the Schedule of Benefits for the listing and its requirements: The ministry condition for EQK names A100 and the requirement for specialty code 00. It does not describe the service, so the Schedule of Benefits is the source for what the listing covers.

Listings and descriptions are from the OHIP Schedule of Benefits. Amounts change with each fee schedule update, so confirm the current value before you rely on it.

Step-by-step: how to clear this rejection

Confirm the code is EQK rather than EQL, since the two share a trigger and report different reasons.
Read the specialty code the claim carried and confirm whether it is 00.
If the specialty code is wrong on the record, correct the registration data rather than the individual claim.
If the specialty code is correct, check the Schedule of Benefits to establish whether A100 was the right listing for this service and this provider.
Submit the accurate claim inside the three-month window from the date of service.

Decide which half is wrong before changing anything. Either the specialty code misrepresents the provider, in which case it is a data fix, or A100 was the wrong listing, in which case resubmitting A100 with an edited specialty code would be inaccurate rather than corrective.

Where the specialty code was wrong in the provider record, expect a block of rejections rather than one. The code is stored, so it has been applied to everything that provider submitted.

Where A100 was simply the wrong selection, fix the template or the favourites list. The next provider to select it will produce the same rejection.

Money you already earned, still unpaid

Recovery is separate work from ongoing billing. Charging only a percentage of what we recover, we review the backlog, correct what your documentation supports, and resubmit. Recent engagements have recovered five- and six-figure amounts, including rejected claims well past the 3-month stale dated deadline going back into 2023.

The alternative is usually your evenings or admin blocks, not billable clinic time. No setup or service fees. Every dollar recovered is money already written off, you keep most of it, and you pay nothing if nothing comes back.

“These claims weren’t chased up on. These claims have been stale dated. You add up the volume of money in there and it’s a consequential sum.”

Dr Sanjay Acharya, on what the recovery review found

Show me what is still recoverable

How to fix it going forward

Restrict A100 in templates and favourites lists to providers whose specialty code is 00.
Validate the specialty code on the provider record when a physician, locum or group affiliation is added or changed.
Check the Schedule of Benefits before adding any restricted listing to a shared code list.
Review the error report weekly, because a registration mismatch repeats on every claim until the record is corrected.

Restricting the listing at the point of selection is the strongest control, because it stops the invalid combination being created. A code that cannot be chosen by an ineligible provider cannot produce EQK.

Registration data deserves the same checking as a new site. The specialty code is invisible during ordinary work and only ever wrong because of a change, so the change is the moment to verify it.

Shared favourites lists are convenient and are a recurring source of restricted-listing rejections. Auditing one is a short task with a long payoff.

Is it recoverable?

Recoverable by resubmission inside the window

Correct the specialty code where the registration data is wrong, or submit the listing that actually applies where A100 was not the right claim, inside the three-month window.

Where the specialty code was recorded incorrectly, this is a routine correction and the claim is fully recoverable inside the window.

Where the specialty code was accurate, there is nothing to resubmit as A100. The recoverable value sits in the listing that correctly describes the service, and the window applies to that claim from the same date of service.

After the window closes, INFOBulletin 230402 allows claims that reached the Claims Error Report inside three months to be corrected and resubmitted through the ministry stale-date process, with the report line evidencing timely submission. A claim never submitted inside the window runs through a written application instead, which this page does not set out.

For in-province services on or after 1 April 2023, claims must be submitted within three months of the date of service, not six. Ontario INFOBulletin 230402 is the Ministry notice. Many third-party pages still quote six months. That window is closed for current work. If the original claim reached the Claims Error Report inside three months, a corrected resubmission can still be filed after the window in the Ministry's stale-date process. If the claim was never submitted in time, payment may be recoverable by written application. That is not a routine resubmit.

Related codes

Frequently asked questions

What does OHIP error code EQK mean?: EQK means fee schedule code A100 was billed with a specialty code other than 00. That single circumstance is the whole ministry condition.
Can I resubmit A100 under a different specialty code?: Only if the specialty code on the original claim was recorded incorrectly. If it accurately described the provider, A100 was not the right listing, and changing the specialty code to pass the edit would make the claim inaccurate.
What is the difference between EQK and EQL?: Both are triggered by A100 billed with a specialty code other than 00. EQK reports that the master number does not meet criteria, while EQL reports that the physician is not eligible to claim the code and also covers providers with an Emergency Department Alternate Funding arrangement group number.
Why did a block of claims reject with EQK at once?: Because the specialty code is stored on the provider record rather than entered per claim. If it is wrong, it applies to everything that provider submitted until the record is corrected.

References

For how error reports relate to the remittance advice, see how to read your OHIP remittance advice and what rejection codes actually mean. Official wording for this code: Ministry of Health, Error Report Rejection Conditions (December 2022).