OHIP Error Code - TM5 - Virtual Care Claim Already Paid for This Patient

Background

The “TM5” error code will be issued and the entire claim will be rejected and returned on the physician’s/dentist’s error report if a non-virtual care claim is submitted and paid for a virtual care claim that was already made to the same physician/dentist for the same patient on the same date of service. (This error condition will not apply if the non-virtual care claim is for services that are excluded from the Virtual Care Program.)

Solution

If the non-virtual care claim (i.e. OHIP claim) was submitted for services omitted from the virtual care claim then the physician/dentist will have to request an adjustment be processed by OHIP through existing claims adjustment procedures to amend the original virtual care claim. If the non-virtual care claim and virtual care claim are correct because the physician/dentist in fact rendered both services on the same day in both virtual care and non-virtual care settings, then the rejected non-virtual care claim should be resubmitted with the "Manual Review" indicator checked and written explanation provided for adjudication purposes.

For the instruction on how to flag Manual Review, see OHIP Billing Tip #11 - Manual Review