Understanding Your OHIP Remittance Advice (RA)
Your Remittance Advice tells you exactly what OHIP paid, rejected, and adjusted. Here's how to read it — and what to do when something's wrong.
SnapBill Team
OHIP Billing Experts
Understanding Your OHIP Remittance Advice
Every month, OHIP sends you a Remittance Advice (RA) through the Medical Claims Electronic Data Transfer (MCEDT) system. This document is your billing statement — it shows what was paid, what was rejected, and what was adjusted.
If you're not reviewing your RA regularly, you're likely leaving money on the table.
What's in an RA?
Your Remittance Advice contains several key sections:
- Paid claims: Claims that were accepted and processed at the Schedule of Benefits rate
- Rejected claims: Claims that OHIP couldn't process, with error codes explaining why
- Adjusted claims: Claims where OHIP paid a different amount than what you billed (e.g., fee reductions, maximum limits)
- Summary totals: Your gross billings, deductions, and net payment for the period
Common RA Explanatory Codes
Two different code sets show up in the OHIP payment cycle, and mixing them up wastes a lot of time.
Error codes appear on the error report you get back shortly after submitting a batch. They mean the claim never entered adjudication — it was rejected on format or eligibility. RA explanatory codes appear on the Remittance Advice itself, and they explain what the ministry decided about a claim it did adjudicate: paid as billed, paid at a different amount, or not paid.
Here are RA explanatory codes you'll see regularly:
| Code | Meaning |
|---|---|
| 33 | Approved |
| 50 | Paid in accordance with the Schedule of Benefits |
| 51 | Fee Schedule Code changed in accordance with Schedule of Benefits |
| 32 | OHIP records show service(s) on this day claimed previously |
| 35 | OHIP records show this service rendered has been claimed previously |
| 40 | Service or related service allowed only once for same patient |
| 45 | Specialty code restriction on Fee Schedule Code |
| 54 | Interim payment — claim under review |
| 56 | Claim under review |
| 57 | This payment is an adjustment on an earlier account |
| C2 | Allowed at re-assessment fee |
| C3 | Allowed at minor assessment fee |
| C4 | Consultation not allowed with this service — paid as assessment |
| D2 | Additional procedures allowed at 50% |
| D3 | Not allowed in addition to visit fee |
Note that most of these are not rejections. Codes 51, C2, C3, C4 and D2 all mean you were paid — just at a different code or a different amount than you submitted. Those are the ones worth reading closely, because a pattern of downgrades usually points at a fixable habit rather than a one-off.
Codes 54 and 56 mean the claim is still under review. Resubmitting a claim sitting at 54 or 56 is a common and expensive mistake — it typically comes back as a duplicate.
Each genuine rejection is an opportunity to correct and resubmit — if you catch it within the 6-month window. For a deeper dive into preventing these, see 5 Ways to Reduce OHIP Claim Rejections and our full breakdown of OHIP rejection and error codes.
Reconciliation: Why It Matters
Reconciliation is the process of matching your RA payments back to the claims you submitted. Without it, you won't know:
- Which claims were paid at the expected rate
- Which rejections need resubmission
- Whether your total payments match your expected billings
Many physicians skip reconciliation because it's tedious. That's a mistake — unreconciled accounts consistently show 3-5% revenue leakage. If you're thinking about switching billing platforms, reconciliation capabilities should be at the top of your checklist.
How SnapBill Handles Reconciliation
SnapBill automatically downloads your RA files, matches payments to submitted claims, and flags discrepancies. You get a clear dashboard showing:
- Paid vs. expected amounts
- Outstanding rejections with suggested fixes
- Trends in your rejection rate over time
No spreadsheets. No manual matching. Just a clear picture of your billing health.
Stop guessing what OHIP paid you. Start with SnapBill and get automatic reconciliation from day one.
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