Bulletin 220903 — New Explanatory Code ‘W3’
The ministry will introduce a new explanatory code for claims older than three months starting on the October Remittance Advice.
To: OHIP Billing Software Vendors
Category: Billing Software Specifications
Written by: Claims Services Branch; OHIP, Pharmaceuticals and Devices Division
Date issued: September 15, 2022
New Explanatory Code
Starting on the October 2022 Remittance Advice, a new Explanatory Code ‘W3- Service date is older than 3 months’ will begin to appear. This explanatory code is to alert providers that a claim was submitted more than three months after the service date.
Claims that receive the ‘W3’ explanatory code will still be processed for payment.
Stale date claim submissions
The OHIP claims system will determine whether a claim is stale dated and reject the claim to the provider’s error report accordingly. Certain stale dated claims may be submitted to the ministry where approval has been provided due to extenuating circumstances and OHIP technical specifications documentation includes the ability to submit stale dated claim files. Providers should have the ability to choose the file type of their submission (regular claim file or stale dated claim file) regardless of service date. The ministry encourages software vendors to avoid implementing controls that do not comply the with the technical specifications and prevent the submission of claims that may be accepted by the OHIP claims system.
Technical bulletin; vendor; explan; explanatory code; W3; stale date; claims submission window; RA; remittance advice