Error report · Referral & provider
OHIP error code HCE
Patient enrolled to billing physician but later than 3 months from the "referred to" date on HCC database-Enrolment after 3 Months
What HCE means
The Ministry of Health’s official wording for HCE is: “Patient enrolled to billing physician but later than 3 months from the "referred to" date on HCC database-Enrolment after 3 Months.”
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 HCE
The patient was enrolled more than 3 months after the Health Care Connect 'referred to' date - the HCC bonus doesn't apply; bill the standard enrolment code instead.
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
- 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
- EQSPractitioner Criteria Not Met
- 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
- PA2Invalid PA Claim - Physician Assistant Pilot (PA) claim submissions with the PA as the submitting physician must identify the solo billing number of the supervising physician in the "Refer Physician" field.
- PA3Not registered for PA - The physician and/or referring physician fields on the PA Pilot claim submission contain billing numbers which are not affiliated to the PA Pilot group number.
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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.