Error report · Referral & provider
OHIP error code EQS
Practitioner Criteria Not Met
What EQS means
The Ministry of Health’s official wording for EQS is: “Practitioner Criteria Not Met.”
This code appears on your Claims Error Report (downloaded through MCEDT). It means the claim was rejected at submission and was never adjudicated for payment — fix the issue below and resubmit the claim.
How to fix EQS
You don't meet the practitioner criteria required for this code - confirm the eligibility criteria with the Ministry before resubmitting.
Referral and provider codes relate to the referring or rendering provider number, specialty restrictions, or referral requirements attached to the fee code. Verify the provider numbers on the claim and whether the code requires a valid referral.
Related codes
- EQJPractitioner Not Eligible On Service Date - New Graduate bills New Patient fee (Q013) or Physician (not a new graduate) bills new Graduate-New Patient fee (Q033).
- EQKMaster Number (MNI) Does not Meet Criteria - A100 billed with a specialty code other than 00.
- EQLPhysician Not Eligible to Claim FSC - A100 billed with a speciality code other than 00 or billed by provider with any Emergency Department Alternate Funding arrangement (EDAFA) group number.
- EQMNot Registered for Use
- ERFReferring physician number is currently ineligible for referrals
- ESDAPP group affiliation on service date - Hospital Emergency Department is part of an alternative funding agreement
- HCCNot on Health Care Connect (HCC) database-Not Eligible On HCC database but not Complex-Vulnerable On HCC database but not in 'referred to' status
- HCEPatient enrolled to billing physician but later than 3 months from the "referred to" date on HCC database-Enrolment after 3 Months
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Code meaning per Ontario Ministry of Health — Error Report Rejection Conditions / Error Codes (December 2022). The suggested action is general information for Ontario physicians, not billing, legal, or tax advice — codes and rules change, so verify against the current Ministry of Health documents before relying on a claim.