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Ontario Physicians - Understanding A Claim Status
Ontario Physicians - Understanding A Claim Status

What does the status of my claim mean?

Megan Halstead avatar
Written by Megan Halstead
Updated over a week ago

Submitted to Insurer: This claim has been submitted to OHIP. Depending on when the claim was submitted prior to the latest cut off, your claim could be processed for the next remittance. For a more detailed explanation of cut offs and remittance schedules please see  OHIP Cut Off Schedule

Submission Error: The claim has not passed the pre-edit process and therefore has not been officially received. Patient insurance issues are often the cause for this. Other examples could be a missing referring practitioner or incomplete times in the claim. Please see the specific claim details for a full explanation of what is missing. 

Rejected: This claim has been rejected by OHIP as the billing criteria has not been met for successful payment. Please go into the claim details to see the full explanation as to why these claims have come back unpaid. 

Pending: This claim will be automatically submitted to OHIP within the next 24 hours if your account is fully active. 

Want to know how to maximize your Ontario Billing? Check out our OHIP Billing Guide.

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