OHIP Claim Rejected? 5 Fast Fixes to Get Paid Without the Headache
If you’ve had an OHIP claim rejected, you know the frustration. You’ve already done the work, the paperwork is submitted, and then OHIP tells you “No.” The truth is, most rejections are fixable — and if you know how to handle them, you can turn unpaid work into revenue you’ve already earned.
Here are the five most common reasons OHIP rejects claims, the fast fixes you can try, and how we make sure you get paid every time.
1. Ontario Health Card & Eligibility Issues Triggering OHIP Rejections
What’s happening: Patient’s health card has expired, the version code is wrong, or validation wasn’t done at the visit.
Fast fix: Validate the card in real-time using the Health Card Validation tool and resubmit with the updated details. Hold your admin team accountable for these kinds of error codes and reward months where there are zero version code or related errors.
Pro tip: Always validate at the time of service — don’t wait until the claim bounces.
How we help: We run validation checks for you, so you don’t lose money on claims that get stale-dated while you’re busy seeing patients.
2. Wrong or Missing OHIP Codes
What’s happening: Fee code doesn’t match the diagnostic code, or a required element is missing.
Fast fix: Cross-check your claim against the OHIP schedule of benefits and resubmit with the correct code.
Pro tip: Most rejections come from the same small set of mismatched code pairs. Once you know them, you stop making the same mistake.
How we help: We see patterns across hundreds of doctors, so we flag coding issues before OHIP rejects them.
3. Stale-Dated Claims (VJ7 Errors)
What’s happening: Claims submitted more than 3 months after service automatically get rejected.
Fast fix: If you miss the deadline, you may be able to apply for an exception through the Eligibility Review Committee — but it’s a hassle.
Pro tip: Build a one-month buffer into your workflow. If you’re cutting it close every time, your system is broken and it’s likely the most expensive habit you have.
How we help: We keep you inside the submission window, and when exceptions are needed, we handle them.
4. Patient-Physician Relationship Errors (AT3, VH9)
What’s happening: OHIP doesn’t recognize a valid patient-physician link — often because a referral is missing or the patient isn’t rostered.
Fast fix: Check the patient’s roster status or referral details and correct the claim.
Pro tip: Hospitalists and specialists see this all the time. One missing referral letter can cost thousands.
How we help: We correct and resubmit systematically so these don’t become a recurring issue.
5. Duplicate or Technical Errors
What’s happening: The claim was submitted twice, or the file format from your EMR was off.
Fast fix: Identify and resubmit only the correct version with the right formatting.
Pro tip: If you see codes like “VH0” or “EH2,” it’s usually a file formatting issue, not a true billing problem.
How we help: We integrate across EMRs and MCEDT so you don’t waste time troubleshooting technical glitches.
The Bottom Line
Rejected OHIP claims don’t have to be lost revenue. They’re fixable — but only if you catch them early, know the right fix, and resubmit in time.
At Physicians First, 100% of our clients have made more net revenue after working with us, because we don’t just resubmit claims — we solve the root cause of rejections and stop them from happening again.
Get in touch to learn more today!
