Remittance Advice · Payment-time (remittance)
OHIP explanatory code J5
Coverage Applied For; Premiums Not Yet Paid
What J5 means
The Ministry of Health’s official wording for J5 is: “Coverage Applied For; Premiums Not Yet Paid.”
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 J5
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
- I9Payment not applicable/expired
- J1Service Date is Before the Effective Date of OHIP Coverage
- J2Service Date is After the Termination of Coverage Date
- J3Approved for stale dated processing
- J7Claim submitted three months after service date
- J8Coverage Not In Effect; Services Provided On Or After The 20th Of This Month Will Not Be Paid Unless Subscriber Takes Corrective Action
- J9Coverage Reinstated. Submit Claims Routinely
- L1This service paid to another laboratory
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Code meaning per Ontario Ministry of Health — Remittance Advice Explanatory Codes / Messages (March 2026). 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.