 Common Explanatory
Codes
I2 – Service is globally funded
This explanatory code will appear on the monthly RA if a claim
is submitted for a complement funded service for an enrolled
or non-enrolled patient. The claim will pay at zero dollars.
I6 – Premium not applicable
This explanatory code will appear on the monthly RA if a Q
code is billed for a patient who is not enrolled in the MOHLTC
database on the service date. The assessment code billed along
with the Q code will be paid (subject to all other MOHLTC
rules).
I9 – Payment not applied/expired
This explanatory code will appear on the monthly RA if a Q200A
is billed by a HIV Physician whose payment eligibility period
for the Q200A has ended. The patient is successfully enrolled
on the MOHLTC database; however the $5.00 PPRF will not pay.
30 – This service is not a benefit of MOHLTC
This explanatory code will appear on the RA for claims using
the Q020A, Q021A, and Q022A tracking codes. The tracking codes
are billed at zero dollars and will pay at zero dollars with
an explanatory code 30. Common Rejection Codes
A2A – Outside Age Limit
The service has been billed for a patient whose age is
outside of the criteria for that service.
A3H – Maximum number of services
The number of services on a single claim for a Q012A
code is one.
AD9 – Not allowed alone
Claims are being submitted without a valid assessment
code on the same service date.
EPA – PCN billing not approved
Claim for Q code submitted for a patient with a service
date prior to the physician’s effective date, or a claim
for a Q code for which a physician is not eligible.
EP1 – Enrolment transaction not allowed
A Q200A code submitted for a patient with an incorrect
version code, or who is either enrolled with another
physician with the same effective date, or for a patient
who should contact their local MOHLTC office regarding
their eligibility. HIV Model Billing and Payment Fact
Sheet 25 of 28 Version 1.2 December 2009
EP3 – Check service date/enrolment date
A Q200A has been submitted by a physician for a patient
that already has an existing enrolment to the same
physician with a different date.
EP4 – Enrolment restriction applied
A Q200A code submitted for a patient who has attempted
to enrol with another family physician before six weeks
has passed or attempted to enrol with more than two
physicians in the same year.
EP5 – Incorrect fee schedule code for group type
A Q-code submitted is incorrect for group type.
PAA - No Initial Fee Previously Paid
A Q042A has been submitted with a service date that is
not within the 365 day period following the service date
of a Q041A fee code. /p>
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