OHIP Remittance Advice code J5

Coverage Applied For; Premiums Not Yet Paid

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.

Check the patient's details and eligibility

This is about the patient, not the coding: the health number, version code, eligibility dates or registration details. Confirm them against the health card or with the patient, correct the claim, and resubmit. Changing the fee code won't help.

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

• EV · Check health card for current version code
• GF · Coverage lapsed-bill patient for future claims
• J1 · Service Date is Before the Effective Date of OHIP Coverage
• J2 · Service Date is After the Termination of Coverage Date
• J8 · Coverage Not In Effect; Services Provided On Or After The 20th Of This Month Will Not Be Paid Unless Subscriber Takes Corrective Action
• J9 · Coverage Reinstated. Submit Claims Routinely