OHIP Expl. Codes 55 & 57

There are cases where OHIP determines that certain service codes were "not paid properly" on past claims. In these cases the OHIP claims processing system selects the entire claim and reprocesses it. A single claim can include multiple fee schedule codes and all codes will be reprocessed. Claims that were reprocessed with no change in payment will appear on the Remittance Advice (RA) with explanatory code ‘55-This deduction is an adjustment on an earlier account’ and ‘57-This payment is an adjustment on an earlier account’. These two transactions will net out to zero with no payment impact but will report on the RA for reconciliation purposes.