OHIP explanatory code E4

What E4 means

The Ministry of Health’s official wording for E4 is: “Service date after the eligibility termination date.”

This code appears as an explanatory code on your monthly Remittance Advice (RA). It means the claim was adjudicated — paid, reduced, or refused — for the reason below. A claim already on your RA generally shouldn't be blindly resubmitted; follow the suggested action.

How to fix E4

Check the patient eligibility and health card for the service date. If they were covered, file a Remittance Advice Inquiry; otherwise bill the correct payer.

Payment-time codes appear on the monthly Remittance Advice after adjudication. Some are informational, some explain a reduced or refused payment. Where you disagree with the outcome, the usual route is a Remittance Advice Inquiry or written inquiry — not resubmitting the same claim, which can create a duplicate.

Related codes

• DXDiagnostic code not eligible with Fee Schedule Code
• E1Service date prior to start of eligibility
• E2Incorrect version code for service date
• E3Version Code not on File for HN (Health Number)
• E5Service date not within an eligible period
• E6Service Date after Eligibility End Date - Eligibility Terminated as MOH Records Indicate Patient Deceased
• E9Service Date after Eligibility End Date - Eligibility Terminated Due to no Response to Notice to Register
• EAService date is not within an eligible period - Services provided on or after the 20th of this month will not be paid unless eligibility status changes