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E003C Code - Rejection - Explanation Required

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How to provide an explanation to OHIP Ministry of Health

Question: 

I just had a few rejections back regarding billing for Anesthesia Stand-by E003C. The error code asks for an explanation code to be included with the claim. Can you explain where to find and input this?

My friend also just started using mdbilling.ca and her claims were entered without an explanation code the same way I did, and hers went through without any problem.

Answer: 

You will need to set your claim for "manual review", and submit a FAX with your explanation to your Claim Assessor or use eSubmit. Depending on the district office you are assigned, you will need to fax your documentation to a specific number.

Please contact MoH at their toll free number 1-800-262-6524, they will help you to connect with your Claims Assessor and you can find out your district office.

For your manual review letters, MoH district office fax numbers are below:

Toronto 416-314-7518
Hamilton 905-546-8287
Oshawa 905-434-4186

 

Your colleague may have his/her claims rejected depending on other codes being billed on the same date. Occasionally - we also see inconsistent rules being applied depending on the Claim Assessor handling the claim.

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