Bulletin 250502 — Reminder: Health card validation
Patient health cards should be validated at every visit
To: All Physicians, Hospitals, Community Laboratories, Community Surgical and Diagnostic Centres, Optometrists, Hospital-based Dentists, Podiatrists
Category: Physician Services, Primary Health Care Services, Community Surgical and Diagnostic Centres, Optometrist Services, Dentist Services, Podiatrist Services
Written by: Claims Services Branch, Health Programs and Delivery Division
Date issued: May 21, 2025
Bulletin Number: 250502
Reminder: validate health cards at every visit
The Ministry of Health’s Health Card Validation service helps health care providers and other clients determine patient eligibility and the validity of an Ontario health card.
Providers should ask for an individual’s most recent health card and validate it each time the patient visits. Validating each visit will help reduce the number of claims that are rejected due to patient ineligibility.
Health cards that pass validation should be accepted and standard OHIP claim submission procedures should be followed. A card that passes validation will receive a response code between 50 and 55 from the ministry’s Health Card Validation system.
If a health card does not pass validation, health care providers should take the following steps:
- check for keying errors
- confirm the health number and version code
- ask if the cardholder has another health card
- ask the cardholder to contact ServiceOntario to update their health card registration
If a patient presents without a health card or with an invalid card, a provider may charge the patient for services provided.
However, if it is later determined that the patient was eligible for OHIP coverage on the service date, the patient may return to the provider requesting that they be reimbursed the full amount.
It is a violation of the Commitment to the Future of Medicare Act (CFMA) for a person or entity to charge OHIP-insured persons for an insured service or a component of an insured service (known as “extra billing”); to pay or receive a fee or benefit from an insured person for providing preferred access to an insured service (known as “queue-jumping”); and/or to make the provision of an insured service conditional upon an insured person paying a block fee for uninsured services. For additional information, the HIA and the CFMA are available on the government website at ontario.ca/laws.
If a claim was previously rejected due to an invalid version code or health card eligibility issue, the provider must resubmit the claim for payment once the patient presents with a new valid health card and version code.
Further information regarding Health Card Validation can be found in the Health Card Validation Reference Manual.
Keywords/Tags
health card; OHIP card; health card validation; HCV; eligibility
Contact information
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