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AC1 Rejection (AC1 Error) - Maximum reached

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The claim rejections are returned by the MoH.  The 'Rejection Report' is the summary of the rejected claims generated by MDBilling.ca.  Rejected claims can be fixed and resubmitted - no need to resubmit as a new claim.

Explanation:

You have reached the maximum number of times you can bill this code within a time period.  For example, consults/(re) assessments have limits on the number of times you can bill in a 12-month period – refer to the Schedule of Benefits, section GP12 for more details.

Solution:

Consider billing a lower paying code (e.g., if originally billed a Consultation, then resubmit with a Medical Specific Assessment).  Alternatively, if the patient is seen for a second time with a clearly defined unrelated diagnosis, then consider billing the same service code again, but with the different diagnosis code.  Refer to the Schedule of Benefits section GP12 for more details.

 

You can obtain further information by doing the following: 

1. Reviewing the Schedule of Benefits. Here is the link to the SoB: Physician Services Under the Health Insurance Act; or

2. Contacting your Ministry of Health Claim Assessor for advice: How do I find my Claim Assessor?

Please let me know if you have any questions.

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