Ontario
OHIP stale dated claims and rejected claims: how the monthly cycle works
OHIP stale dated claims are claims submitted more than 3 months after the date of service, later than Ontario’s regulation under the Health Insurance Act requires. Claims go through MCEDT on a monthly cycle: claims received by the 18th are typically processed for approval the following month, and rejected claims come back on a Claims Error Report, usually within 48 hours, and must be corrected and resubmitted. This is general information, not legal advice. Review your payer contracts and the rules where you practice with your compliance advisor.
Published by OffshoreMeds. Facts last checked October 10, 2026. How we check our numbers.
The limit
The three-month rule and stale dated claims
Under a regulation to the Health Insurance Act, all claims must be submitted within 3 months of the date of service. A claim submitted after that is termed stale dated (Ontario Ministry of Health). MCEDT, the secure electronic service through which all claims must be submitted, has a Stale Dated Claims file type alongside the Medical Claims file, an Overnight Batch Eligibility Checking file and a supporting-documentation file.
The cycle
The monthly cycle, step by step
| Step | What the Ministry says |
|---|---|
| Step: Submit | What the Ministry says: Through MCEDT, by file upload or by a web service linked to billing software. The Ministry recommends daily or weekly submissions so claims are adjudicated promptly and rejected claims are easier to reconcile. |
| Step: Cut-off | What the Ministry says: The Ministry works on a monthly processing cycle. Claims received by the 18th are typically processed for approval the following month, with the deadline moving to the next business day when the 18th is a weekend or holiday. Claims received after it may not be approved until the next cycle. |
| Step: Batch Edit Report | What the Ministry says: Tells you whether a batch was accepted or rejected, usually within 24 hours. After a weekend, holiday or month-end upload it arrives on the next claims processing day. |
| Step: Claims Error Report | What the Ministry says: Lists rejected claims with error codes, usually within 48 hours of the file. Rejected items drop out of the payment stream until they are corrected and resubmitted. |
| Step: Remittance Advice | What the Ministry says: A monthly statement of approved claims, available between the 5th and 7th of the month after a successful submission. Payment should follow on or before the 15th. |
Rejected claims
Reading the error codes and correcting claims
Each Claims Error Report gives a three-character error code for a rejected claim, at the claim header or the item level, and a claim can carry more than one. The first character is a letter that names the type of rejection.
| Letter | Type of rejection | Applies to |
|---|---|---|
| Letter: V | Type of rejection: Validity error | Applies to: HCP, WCB and RMB payment programs |
| Letter: A | Type of rejection: Assessment error | Applies to: HCP, WCB and RMB payment programs |
| Letter: E | Type of rejection: Eligibility error | Applies to: HCP, WCB and RMB payment programs |
| Letter: R | Type of rejection: Reciprocal Medical Billing specific error | Applies to: Reciprocal Medical Billing |
| Letter: T | Type of rejection: Telemedicine error | Applies to: HCP payment programs |
A rejected item may carry an error report message below it with more detail on why it was returned. Rejected items are returned during the processing month, and the Ministry says to resubmit the corrected information immediately: if it arrives before the 18th of the same month, the claim can be processed for payment in the same billing cycle.
In practice
Working the cycle
- Submit daily or weekly, as the Ministry recommends, so errors surface early and stale dating stays far away.
- Keep each month’s Claims Error Reports on file: if an item is missing from the Remittance Advice, check that month’s Error Report to see whether it was rejected and needs to be submitted again.
- Correct and resubmit rejected items at once, and before the cut-off where you can.
- Watch the three-month limit on anything that sits unresolved. Where documentation is needed, the Ministry describes a manual review indicator and electronic submission of supporting documents.
- MCEDT lets a physician designate administrative staff, third-party agents or other providers to submit or reconcile claim files, and the physician stays responsible for all claims submitted under the billing number (INFOBulletin 4656).
The OHIP billing staff page covers how a billing seat fits MCEDT and the privacy rules. Following up rejected and aged claims is the work of denial management staff, pre-visit checks including the overnight eligibility file belong to insurance eligibility verification staff, and filing deadlines in other systems are in timely filing limits for medical claims. This is general information, not legal advice. Review your payer contracts and the rules where you practice with your compliance advisor.
The terms behind each seat
One flat monthly fee per seat, never a percentage of collections. A Business Associate Agreement is signed before anyone touches protected health information. Clinical decisions stay with your US-licensed providers. See all OffshoreMeds services.
Related guides
- OHIP billing staff for Ontario
How designated billing agents fit MCEDT, and what PHIPA and PIPEDA say about offshore agents.
- Denial management staff
Appeals, A/R follow-up and root-cause work, measured against published denial-rate benchmarks.
- Timely filing limits for medical claims
The federal caps, examples from Cigna, Aetna, Texas Medicaid and Illinois Medicaid, and how to find and track the limit that applies.
- Insurance eligibility verification staff
Coverage, benefits, authorization and patient-cost checks done before the visit, not after the denial.
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