The OHIP Remittance Advice (RA) is the monthly statement that reconciles what you submitted against what the ministry paid. It arrives through MCEDT in the first days of each month, covers claims that reached OHIP by the 18th of the previous month, and is the only place the ministry explains a reduced or refused payment. Each adjusted line carries an explanatory code — a two- or three-character code such as 35, EV or D7 — that names the rule that was applied.
IntelAGENT retrieves every RA and reconciles it line by line, so the cycle arrives as a list of exceptions rather than a file to decode. See how →
Physicians usually meet the Remittance Advice for the first time when a deposit looks wrong. The EFT lands, the number is smaller than expected, and there is no obvious reason why. The reason is almost always in the RA, written in a shorthand nobody teaches in residency.
This guide walks through the document in the order you should read it, and names the four checks worth doing every cycle.
When the RA arrives, and what it covers
OHIP adjudicates claims on a monthly cycle, not continuously. Three dates matter:
- The 18th of the month — the ministry's cut-off. Claims that arrive by then are adjudicated in that month's run. Claims that arrive on the 19th wait for the next one.
- The first days of the following month — the Remittance Advice file becomes available for download through MCEDT, along with the claims error report for anything rejected before adjudication.
- Mid-month — the EFT deposit lands in the bank account registered with the ministry.
The practical consequence: a claim submitted on the 19th of January is not paid until mid-March. That gap is the single biggest reason physicians think a claim was lost when it was only waiting.
Stale-dating. A service rendered on or after April 1, 2023 has to reach OHIP within three months of the service date. A claim that arrives later is rejected to the Claims Error Report as VJ7, stale dated claim. A claim that sat unsubmitted for seven months is not a late claim; it is an unpaid one. Reconciling monthly is how you find those while they can still be fixed with a correction rather than a letter.
The four parts of the document
An RA has a predictable structure, whatever software renders it:
- Header — your billing number, the group number if the claims were submitted under a group, the payment date, and the cycle the file covers.
- Claims detail — one block per claim, listing each service line with the fee you submitted, the fee OHIP allowed, and any explanatory code attached to the line.
- Adjustments — reversals and re-payments of claims from earlier cycles. This is where codes
55and57live. - Totals and deductions — the sum of allowed amounts, less any ministry deductions or recoveries, arriving at the net amount deposited.
The claims detail is where the reading happens. Every line has three numbers worth comparing: what you asked for, what was allowed, and the difference.
Explanatory codes, ranked by how often they actually appear
OHIP publishes several hundred explanatory codes. In practice a short list accounts for the overwhelming majority of what lands on an Ontario physician's RA. These are the ones to learn, ordered by how frequently they turn up in real remittance files:
| Code | Ministry description | What to do |
|---|---|---|
| 57 | This payment is an adjustment on an earlier account | Usually nothing. OHIP is re-paying a claim from a previous cycle. Expect a matching 55. |
| 55 | This deduction is an adjustment on an earlier account | Nothing, if a 57 of similar size accompanies it. A lone 55 is money clawed back — find the original claim. |
| 30 | This service is not a benefit of the ministry | The service is not insured for this patient or in this circumstance. If the patient is uninsured, bill them privately instead. |
| 35 | Ministry records show this service rendered by you has been claimed previously | A duplicate. Check whether it was genuinely submitted twice, or whether a resubmission collided with the original. |
| EV | Check health card for current version | The version code on file has changed. Re-validate the card and resubmit with the current version code. |
| DF | Corresponding Procedure Invalid, Omitted or Paid at Zero | A premium or add-on was billed without the base procedure it attaches to. Resubmit the pair together. |
| V4 | Date of service was not a Saturday, Sunday, or a statutory holiday | A weekend or holiday premium was claimed for a weekday. Rebill with the correct premium for that day and time. |
| I2 | Service is globally funded | The service is covered by a global or alternate funding arrangement, so no fee-for-service payment is due. |
| D7 | Not allowed in addition to other procedure | Two codes that cannot be billed together. Keep the one with the higher fee unless the preamble says otherwise. |
| D3 | Not allowed in addition to visit fee | A procedure was billed alongside an assessment that already includes it. |
| MD | Daily maximum has been exceeded | You hit a per-day cap on that service. Nothing to resubmit; worth knowing the cap exists. |
| 36 | Ministry records show this service has been rendered by another practitioner, group, lab | Another provider claimed the same service for the same patient and date. Confirm who actually rendered it. |
| 51 | Fee Schedule Code changed in accordance with Schedule of Benefits | OHIP substituted a different code. Compare the allowed amount against the code it paid. |
| S3 | Second surgical procedure allowed at 85% | Expected behaviour under the surgical preamble. The reduction is correct. |
| M1 | Maximum fee allowed or maximum number of services has been reached same/any provider | A service limit was reached, possibly by another provider. Nothing to resubmit. |
Two things are worth noticing about that list. First, the top two codes are not errors at all — they are OHIP's bookkeeping for adjustments, and they dominate every RA. Second, only a handful of the frequent codes are genuinely actionable: EV, DF, V4, 35 and 30. Everything else is the ministry telling you a rule applied correctly.
For the codes that stop a claim before adjudication — the ones that arrive on the claims error report rather than the RA — see our guide to common OHIP claim rejections.
Codes 55 and 57: the pair to understand
Nothing on an RA confuses physicians more than seeing a payment and a deduction for the same claim in the same file.
OHIP cannot edit a payment it has already made. To change one, it reverses the original in full (a deduction, code 55) and issues a fresh payment at the corrected amount (code 57). Both legs appear on the RA, and the net effect is the difference between them.
So:
- A
55and a57of equal size — a no-op. OHIP reversed and re-paid the same amount, usually because something administrative changed. - A
57larger than the55— you were underpaid before and have now been topped up. - A
55larger than the57— a partial clawback. Find the original claim and the reason. - A
55with no57at all — the full payment was taken back. This is the one to chase.
Why netting matters. If you reconcile by adding up the payment lines and ignoring the deductions, your revenue figure will be wrong by the size of the adjustments — and on a typical RA the adjustment lines outnumber everything else. The settled position for a service is the payment line net of any deduction against it, not the sum of the credits.
The four checks worth doing every cycle
-
Does the RA total match the deposit?
Compare the net amount on the RA against the EFT that landed in the account. They should agree to the cent. If the deposit is missing entirely, the most common cause is stale banking information at the ministry — a returned EFT does not announce itself.
-
Which claims are not on it at all?
A claim that is neither paid, reduced, nor refused is a claim OHIP never adjudicated. It either failed file validation before it reached adjudication — in which case it is on the claims error report, not the RA — or it was never submitted. This is where most genuinely lost revenue hides.
-
Where did paid differ from claimed, and why?
Sort the detail by the gap between submitted and allowed. Reductions explained by
S3,50or51are the schedule working as written. Reductions explained byEV,DForV4are correctable, and worth correcting before the submission window closes. -
Are there deductions without a matching payment?
Scan the adjustment section for
55lines with no partner57. Each one is a reversal of a payment you already banked.
Your Remittance Advice, already reconciled
The RA is a flat file built for machines, not a report built for reading. Every check in the section above is work a computer should have finished before you look at it.
- Every RA retrieved as it is released. Remittance files come back over our own MCEDT connection, so a cycle cannot be missed because nobody logged in.
- Each line matched to the claim that produced it. You see the settled position per service — paid, reduced with the ministry's own explanation attached, or refused — instead of a payment total you have to work backwards from.
- Group payments split to the rendering physician. The part that is genuinely tedious by hand, and the part a spreadsheet gets wrong when a reversal lands two months later.
- An afternoon becomes a list of exceptions. The web portal shows the most recent RA next to the claims that still need attention.
- Disputes start from the claim. Where a reduction is wrong, the Remittance Advice Inquiry is filed from the claim record and stays attached to it until the answer lands.
Three months free, then 0.25% of paid claims, capped at $39.99 a month. IntelAGENT has submitted OHIP claims since 2016 for more than 2,000 Ontario physicians.
If a reduced payment is wrong, the correction route is a Remittance Advice Inquiry (RAI) — a formal request to the ministry to re-examine an adjudicated claim, submitted with supporting documentation such as an operative note. That is a different process from resubmitting a rejected claim, and it has its own deadlines.
Frequently asked questions
When is the OHIP Remittance Advice released?
OHIP runs its payment cycle once a month. Claims that reach the ministry by the 18th of a month are adjudicated in that month's run, and the Remittance Advice is made available for download in the first few days of the following month, with the EFT deposit landing mid-month. Claims submitted after the 18th roll into the next cycle.
What is the difference between the claimed amount and the paid amount on an RA?
The claimed amount is what you submitted. The paid amount is what OHIP allowed after adjudication. A difference is not necessarily an error: the ministry reduces fees under rules such as the second-surgical-procedure rule, applies its own fee schedule amount when yours differs, or pays nothing because the service is not insured. Every reduction carries an explanatory code that tells you which rule applied.
Do I have to download the Remittance Advice myself?
Someone does. The RA is delivered as a file through MCEDT and must be downloaded before OHIP eventually stops listing it. Billing software with MCEDT access downloads it automatically and reconciles it against your submitted claims. If you bill without software, you or your agent must log in and retrieve each file.
What do error codes 55 and 57 mean on an OHIP Remittance Advice?
Code 57 is a payment adjustment on an earlier account and code 55 is a deduction on an earlier account. They appear as a pair when OHIP reverses a claim it paid in a previous cycle and re-pays it at a different amount. Together they are the most common codes on any RA and usually require no action, but a 55 with no matching 57 is money taken back and not returned.
Sources
- OHIP Schedule of Benefits and fees — Government of Ontario. The General Preamble sets the payment rules the explanatory codes refer to.
- Medical Claims Electronic Data Transfer (MCEDT) — Ontario Ministry of Health. How remittance files are delivered and retrieved.
- Physician payment — Ontario Ministry of Health.
Code descriptions in the table above are the ministry's own wording as it appears in remittance files. Ordering reflects how often each code occurs across the remittance data IntelAGENT processes. Verify any specific payment rule against the current Schedule of Benefits before acting on it.
Related reading
Common OHIP claim rejections
The codes that stop a claim before it is ever adjudicated, and how to clear each one.
GuideHow to register for MCEDT
GO Secure, the ministry letter, and the designee step that billing software depends on.
GuideHow to reduce missed OHIP billings
Where revenue actually leaks, in the order it is worth fixing.
ProductThe IntelAGENT web portal
Every RA reconciled line by line against your claims.