Two MOH INFOBulletins landed within days of each other this cycle, and both change how specific claims get paid. One reopens a window to resubmit colonoscopy claims that were rejected or paid at zero. The other fixes a billing error that has been underpaying emergency department physicians since April, and the ministry is running an automatic retroactive adjustment to correct it. Here is what changed and what your billing team should be checking.
Colonoscopy Claims: Resubmission Window Now Open
INFOBulletin 260801, issued August 4, confirms that the claims system updates tied to the new ColonCancerCheck follow-up recommendations are complete. As of August 1, 2026, physicians who held back eligible claims while the system was being updated can now submit them. More importantly, any eligible claim that was already rejected, or paid at $0.00 with an explanatory code, can now be resubmitted, provided it meets all three conditions: the service date is on or after July 1, 2026, the claim is for a repeat or follow-up colonoscopy, and it falls within the revised 5-to-10-year follow-up interval.
This follows directly from Ontario Health’s decision to lower the colon cancer screening start age, which we covered in detail last month. The screening-age change gets the attention, but the billing mechanics behind it, specifically how follow-up colonoscopies get paid, are just as important for practices that perform or refer for these procedures.
Emergency Medicine Fee Codes: Nine Revised, Two New, and a Retroactive Fix Coming
INFOBulletin 260803, issued August 7, updates nine emergency department after-hours fee schedule codes and introduces two new ones as part of the phased rollout of the 2024 Physician Services Agreement. The changes were dated effective April 1, 2026, but the claims processing rules needed to actually pay them correctly were not updated in the system until August 1.
The clearest example is H113A. Before August 1, any H113A claim billed for a Friday evening was incorrectly paid at $0.00 with explanatory code V4, because the system did not yet recognize Friday evenings as an eligible period. That has now been fixed going forward, and the ministry has confirmed a Medical Claims Adjustment (MADJ) will run for all nine affected codes to repay claims submitted between April 1 and August 1, 2026, under the corrected rules. The same fix applies to H151A through H154A. A new code, H114A, covers Monday-to-Thursday evening emergency department visits, but billing teams should note it will now be rejected if claimed alongside diagnostic ultrasound services other than J149B or J149C.
Details on the MADJ timing are expected in a future INFOBulletin. No action is required to receive the retroactive payment, but it is worth confirming your billing team knows to expect it rather than treating it as an error when it lands.
A third bulletin landed the same cycle, INFOBulletin 260804, clarifying the Schedule of Benefits for a narrower set of specialty-specific codes. It will not affect most practices, but if your billing software flags an unfamiliar clarification note this month, that is likely the source.
The Bigger Pattern
Both of the changes above are, in effect, the ministry correcting its own claims-processing errors after the fact. That is not a coincidence. The OMA’s “Let’s Fix OHIP” campaign, launched earlier this year, put a number on the scale of the problem: over 1.16 million claims a year sit in manual review, and the OMA estimates resolving that backlog could free up capacity for 58,000 additional patient visits annually. The colonoscopy and emergency medicine fixes are small pieces of that larger claims-processing story, and a reminder that retroactive corrections are becoming a routine part of how OHIP claims get settled rather than a rare exception.
Source: OMA, “Ontario’s Doctors Call on Government to Fix OHIP,” March 2026. oma.org
On the governance side of the same organization, the OMA is also mid-transition to a physician-only board, with two non-physician directors staying on through December 2026 to steward the handover. It is not a billing story, but it is a sign the association pushing hardest on the claims backlog is also restructuring how it governs itself, worth knowing if you follow OMA advocacy closely.
Source: OMA, LinkedIn governance update, August 21, 2026. linkedin.com
What You Should Do
Have your billing team pull any colonoscopy claims from July 1 onward that were rejected or paid at zero, and check them against the three resubmission criteria before refiling. For emergency medicine billers, flag H113A, H151A through H154A, and H114A claims from April 1 onward so the incoming MADJ payment is recognized and reconciled correctly rather than flagged as a discrepancy. Watch for the follow-up INFOBulletin with the MADJ payment date, since that is when the retroactive amounts will actually land.
How MAP Can Help
Retroactive fee code corrections and resubmission windows are exactly the kind of detail that gets missed when a billing team is already stretched thin. MAP Healthcare Consulting and Management’s OHIP Billing and Accounting service line tracks these changes as they land and builds them directly into client billing workflows, so nothing sits unclaimed. Visit maphcm.com to learn more.