OHIP Remittance Advice code M1
Maximum fee allowed or maximum number of service has been reached same/any provider
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.
Resubmitting usually won't change this
OHIP considers the service already paid, claimed by someone else, over its limit, or not insured. A corrected resubmission generally won't be paid. If you believe OHIP's records are wrong, raise it with the ministry instead of resubmitting.
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
- I4 · Records show service has been rendered by another Practitioner, Group or IHF
- J7 · Claim submitted three months after service date
- L1 · This service paid to another laboratory
- L9 · Laboratory services for hospital in-patients or out-patients are not payable on a fee-for-service basis-included in the hospital global budget
- M2 · Maximum allowance for radiographic examination(s) by one or more practitioners
- M3 · Maximum fee allowed for prenatal care
- M4 · Maximum fee allowed for these services by one or more practitioners has been reached
- M5 · Monthly maximum has been reached