OHIP Remittance Advice code 54
Interim payment claim under review
Ontario Ministry of Health, Remittance Advice Explanatory Codes
Where you’ll see it
On your Remittance Advice. The claim was assessed, and this explanatory code says how it was paid, reduced or refused. The Remittance Advice arrives monthly, in the first week.
A submission or documentation step
Something about how the claim was submitted needs to change: a missing field, a manual-review indicator, supporting documentation, or prior approval. Follow the instruction in the ministry's description, then resubmit.
For a claim already on your Remittance Advice, follow the ministry's instruction in the description. That is either a corrected resubmission or a Remittance Advice Inquiry (RAI), and both are still subject to the three-month limit from the date of service.
Our summary is a guide, not a ruling. The ministry’s wording and the current Schedule of Benefits are what OHIP applies. See OHIP Error Report vs Remittance Advice: reading the codes for how the two reports differ.
Related Remittance Advice codes
- 41 · Fee Schedule Code (FSC) Billed No Evidence in Supporting Documentation Provided
- 47 · Not Paid Per 2nd Review by Medical Advisor (MA)
- 49 · Paid according to the average fee for this service. Independent consideration will be given if clinical records/operative reports presented.
- 52 · Fee-for-service assessed by medical consultant
- 56 · Claim under review
- 59 · Practitioner's notification WCB claims
- 62 · Claim assessed by Assessment Officer
- AP · This payment is in accordance with legislation. If you disagree with the payment, you may appeal to the General Manager