Blog # 2 – Medical Billing 101
Did you know adding referring physicians on claims that don’t require it can cause unnecessary rejections???
A number of OHIP billing codes require a referring physician’s billing number to get paid. This is the case for consultations (including telephone and e-consults) & laboratory and certain diagnostic procedures. The latter include any procedure that has a technical and professional component in the Schedule of Benefits, such as ECGs, spirometry, angiograms, etc…
Common error codes EQ6 , ERF , AC4 , ARF , V09
Error codes
AC4 – Unacceptable referral number
One of the four error codes that come up is AC4. This indicates that the billing number of the referring physician is missing or unacceptable. Unacceptable provider numbers here mean that the billing number doesn’t match the category of billing code it was submitted with. For instance, a midwife can only be used as a referral for billing codes such as C813 or C815, not other consultations.
EQ6 – Incorrect referral number
Whereas AC4 was an ‘unacceptable’ number, EQ6 usually means you have a data entry error on your hands. The billing number submitted does not match any provider number currently registered with the Ministry of Health. Check your source for the correct billing number, and resubmit.
ARF – Missing billing number
If you’re billing a code that requires a referring physician – such as a consultation, or a procedure like spirometry or imaging – you must add the 6 digit referring physician billing number to the claim. Most billing software systems force you to add the necessary information, but the odd claim can get by without a referring provider number. These claims will come back ARF. Solution? Add billing number, stir, and resubmit.
ERF – Billing number ineligible for referrals
Here’s a bit of a different beast. ERFs mean the billing number you used is correct, but that physician is either deceased or no longer eligible to practice in Ontario. You’ll have to bill a different code here; in the case of consultations, bill down to an assessment code which pays less and doesn’t require the referring doctor.
V09 – Invalid referral number
V09’s pop up when the provider number doesn’t meet the required criteria. For example, if you submit a 5 digit billing number (omitting the initial zero), your claim will get kicked out with this rejection code. It will also come up if you’ve used a Dentist, Chiropractor or Naturopath’s billing number as a referral (see above for range of billing numbers).
A referring physician is only required when billing a consultation.
*if you add a referring on a claim that it is not required can cause it to reject if there is any issue with the billing number
*the 6 digit CPSO number is different from the 6 digit billing number. A CPSO number will cause the claim to reject
*if the physician is not actively eligible on the CPSO then they are unable to be the referring physician on the claim
What’s in a MOH provider number?
| Billing numbers | Specialties |
| 400000’s | Dentists/Dental surgeons |
| 600000’s | Naturopaths |
| 700000 – 722899 | Midwives |
| 722900 – 799999 | Nurse Practitioners |
| 800000 – 829999 | Optometrists |
| 830000 – 839984 | Chiropractors |
| 900100 – 900600 | Alternate Health Care Professions |
Provider numbers are unique 6 digit numbers that identify physicians and other health professionals such as nurse practitioners to the MOH. These billing numbers generally begin with 0, 1, or 2 for the greater portion of Ontario’s doctors, while other health care practitioners have billing numbers in the ranges specified below.
