How many OHIP claims are rejected each year?

The OMA reported in March 2026 that OHIP processes about 200 million claims a year and rejects about 1.16 million. It also reported that about 58,000 claims can take months to several years to pay.

What happens to a claim rejected on the error report?

According to the Ministry, claims rejected to an error report are deleted from the payment stream. They do not appear on the remittance advice, and they are not paid unless someone corrects and resubmits them.

How long do I have to submit or correct an OHIP claim?

Claims must be submitted within three months of the date of service. Claims submitted after that are stale dated. Inquiries about a claim on your remittance advice should be submitted within seven months of the date of that remittance advice.

Why do high-volume specialists have more rejected claims?

More claims means more chances for the same error to repeat, more complex claims routed to manual review, and more claims at risk of passing the three-month window before anyone corrects them.

Why high-volume specialists lose most to OHIP rejections

Q: Are stale-dated OHIP claims lost for good?

Not always. Claims past the three-month window may be recoverable by written application to the Ministry in some circumstances. Whether a particular claim qualifies depends on its history.

OHIP processes about 200 million claims a year and rejects about 1.16 million of them, according to the OMA. About 58,000 claims take months to several years to pay.¹

The specialists who bill the most claims, and the most complex ones, carry the most rejections. This post covers why volume multiplies the problem, where rejected money goes missing, and what the Ministry's new letters add to it.

Why volume multiplies rejections

A rejection is usually a small error: a health card version code, a missing referring physician number, a service location that does not match. In a practice billing a few dozen claims a week, someone notices. In a practice billing hundreds, the same error repeats across many claims before anyone sees the pattern.

Then the clock matters. Claims must be submitted within three months of the date of service.² The window was cut from six months on 1 April 2023.³ A rejection that sits for a few weeks in a busy practice can be past the deadline by the time it is corrected.

Rejected claims disappear from view

OHIP reports problems in two places, and they behave differently.

The error report. Claims rejected here are deleted from the payment stream, in the Ministry's words.² They are not paid, and they do not appear on the remittance advice. Unless someone reads the error report, corrects each claim and resubmits it, the money is never paid and nothing on the monthly statement shows it is missing.

The remittance advice. Claims that reach the remittance advice have been assessed. Some are paid in full. Some are reduced or refused, with an explanatory code. The Ministry's route for these is an inquiry, submitted within seven months of the remittance advice date, rather than a new claim.²

A physician who reads only the remittance advice sees the second group and never the first. Our guide to reading the remittance advice explains the difference in more detail.

Complex claims wait the longest

Complex claims, especially surgical claims with several codes, are often routed to manual review by a Ministry assessor rather than paid automatically. The OMA reported that this review can take six to nine months.¹

The OMA's own example: Dr. Braden Gammon, director of the University of Ottawa Hand Fellowship Program, spent more than 15 hours in November 2022 reattaching four partially severed fingers. After five resubmissions and repeated calls and emails, he was not paid anything until June 2025.¹

Claims held that long are easy to lose track of. A practice that bills a large volume of complex work can have a significant amount of earned income sitting in review at any time, with no clear record of what is outstanding.

Some failures start outside the practice

Not every rejection traces back to how a claim was coded. The OMA documented two that start elsewhere:¹

During a postal strike, 56 of Dr. Jane Healey's newborn care claims were rejected because registration forms never reached OHIP and then expired.
Dr. Chris Cavacuiti, an addiction physician, described patients waiting three to six months to update health cards, with coverage invalid in the meantime.

Hospital-based specialists see a version of this every week: patient demographics that arrive late from the hospital, referrals missing a referring physician number, version codes that changed since the last visit. The claim still has to be submitted within three months, however long the missing information takes to arrive.

Is the money gone?

Some of it can still be recovered. Claims on the error report can be corrected and resubmitted. Claims reduced on the remittance advice can be raised through an inquiry within seven months. Claims that passed the three-month window may be recoverable by written application to the Ministry in some circumstances.

Which claims qualify depends on each claim's history: when it was first submitted, what came back, and what was done about it. That history is why a backlog is worth looking at early. The longer a rejected claim sits, the fewer routes remain. Our post on stale-dated claims and the VJ7 code covers the three-month rule further.

Rejections and the Ministry's new letters

In late October 2026 the Ministry began writing to physicians whose billing patterns are higher than peers with similar practices. Our explainer covers what the high volume billings letter says.

High-volume specialists can now face both problems at once. Rejected claims mean earned income that was never paid. Meanwhile, the volume of claims that were paid is drawing attention. Rejections can also affect what the Ministry sees: a rejected claim resubmitted more than once, or entered again as a new claim, can make a day look busier than it was.

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

What your billing service should be able to tell you

If someone else submits your claims, they should be able to answer four questions about the last six months without difficulty:

How many claims were rejected, on the error report and on the remittance advice?
How many of those were corrected and paid?
How many are still open, and how old are they?
How many passed the three-month window before anyone fixed them?

Vague answers, or totals with no list of claims behind them, are worth following up.

What we look at

We review the last six months of a specialist's billing, including every rejection on the error report and the remittance advice, what happened to it, and what is still recoverable. For physicians with a backlog, our claims recovery page explains how that work runs. The review is free, and you see what we find before you decide anything.

References

Ontario Medical Association, Doctors going unpaid as OHIP flags 1M-plus claims a year, March 2026.
Ontario Ministry of Health, Claims submission, Resources for physicians.
Ontario Ministry of Health, OHIP InfoBulletins, InfoBulletin 230402, 2023.

If you bill at high volume and want to know what was rejected and never paid, start with a free review of your last six months.