To the attention of all insurance companies licensed to transact
auto insurance in Ontario and all health care providers
With this Bulletin, the Financial Services Commission of Ontario (FSCO) is advising of a change to the Health Claims for Auto Insurance (HCAI) Participating Provider List effective February 1, 2011.
HCAI Participating Provider List
FSCO’s HCAI Participating Provider List has been updated to provide that effective February 1, 2011, every health care facility and health care provider that practices in Ontario and mails or delivers any document to which the HCAI September 2010 Guideline – Superintendent’s Guideline No. 07/10 applies (i.e., Ontario Claim Forms (OCFs) 18, 21 and 23) is deemed to be a Participating Provider. Participating Providers will be required to submit OCFs 18 and 23, and most OCF 21s to HCAI instead of to the insurer to whom the form is addressed. To be able to do so, health care facilities or providers must first enrol with HCAI and agree to specific terms and conditions. The terms and conditions deal with confidentiality, security, liability, access and data integrity.
Insurers that receive OCFs 18, 21 and 23 directly from Participating Providers on and after February 1, 2011 contrary to the Guideline, are under no legal obligation to process or otherwise respond to the forms. However, insurers are requested to contact and inform any such Participating Providers of their obligations in connection with the HCAI system.
HCAI Participant List for Insurers
FSCO stopped maintaining the HCAI Participant List for insurers on May 22, 2010, as the system became mandatory for all insurers that are licensed to transact auto insurance in Ontario and are administering Statutory Accident Benefits Schedule benefits claims under motor vehicle liability policies issued in Ontario.
Additional HCAI Information
Inquiries, questions and additional information on the HCAI system (e.g., enrolment, coding, technical specifications, and educational material) can be found online at: www.hcaiinfo.ca.
If a question is not addressed by this website, please contact HCAI Processing by telephone or e-mail:
Philip Howell
Chief Executive Officer and
Superintendent of Financial Services
January 18, 2011