Revised Health Claims for Auto Insurance Guideline

 
Bulletin
No. [A-02/12]
[Property & Casualty]
[-Auto]
 
To the attention of all insurance companies licensed to transact automobile insurance in Ontario
With this Bulletin, the Financial Services Commission of Ontario (FSCO) is releasing a new Health Claims for Auto Insurance (HCAI) July 2012 Guideline – Superintendent’s Guideline No. 02/12 (new Guideline).  This new Guideline replaces the previous Health Claims for Auto Insurance December 2011 Guideline – Superintendent’s Guideline No. 03/11 (current Guideline) that was issued in December 2011.
 
This new Guideline applies to documents specified in the Guideline that are delivered on or after July 1, 2012, regardless of the date of the accident to which they relate, with the exception of a number of specified additional requirements which apply only to documents delivered on or after November 1, 2012.  
 

New Guideline

FSCO has received feedback from stakeholders regarding difficulty reconciling the Auto Insurance Standard Invoice (OCF-21) to the appropriate Treatment and Assessment Plans (OCF-18) and/or Treatment Confirmation Forms (OCF-23). 
 
To address this issue, the new Guideline provides that the “Plan Number” of the OCF-18 or OCF-23 to which the OCF-21 refers is a mandatory field.  This is the unique “Document Number” generated by the HCAI system when the OCF-18 or OCF-23 to which the OCF-21 refers is submitted, and will enable insurers to properly reconcile invoices.
 
If there is no Plan Number because of a valid business scenario (e.g., the insurer has waived the requirement for an OCF-18 or OCF-23 as applicable) the word “exempt” must be inserted in the Plan Number field and details of the circumstances must be provided in the “Other Information” section of the OCF-21.
 

Recordkeeping

In continuation of FSCO’s focus on the modernization of the auto insurance system, and in consideration of potential physical space constraints on health care providers, the section in the Guideline referring to Recordkeeping is being amended to permit keeping an original paper version or a pdf signed electronic copy of the OCF-21 with an authorized signature on file.
 

Future Amendments to OCF-21, OCF-18 and OCF-23

The HCAI Processing (HCAI-P) system collects and provides de-identified data to the Insurance Bureau of Canada’s (IBC) Health Claims Database regarding auto insurance health claims, which will help FSCO and stakeholders better understand medical and rehabilitation costs and trends. However, there have been gaps identified where additional information is required in order to obtain useful data regarding Minor Injury Guideline (MIG) claims.
 
FSCO will in the near future be issuing an amended OCF-21 form that will be effective for use on and after November 1, 2012 and will contain the following changes:
 
  • The amended OCF-21C form will include two new mandatory additional data fields in which the date that the MIG treatment Block commenced and the profession(s) of the health care provider(s) who provided the treatment are to be identified. In addition, use of the OCF-21C will become mandatory for billing all amounts applicable under the MIG. The OCF-21B and OCF-18 will no longer be approved for use with MIG codes.
  • The amended OCF-21 form will also reflect the requirement, already noted above, that completion of the “Plan Number” field in the manner specified in the Guideline is mandatory effective July 1, 2012.
  • In addition, the OCF-21 will be amended to emphasize specific language appearing above the signature boxes in the form through bolding and increased font sizes. These changes are being made in order to raise the awareness of those individuals signing the form of their responsibility and accountability in doing so. 
    The same changes will be made to the OCF-18 and OCF-23. The current wording in these forms will not change. 
These upcoming form amendments are being announced at this time to provide all affected users with adequate time to identify and make any changes to their systems that may be required to accommodate the amendments. 
 

Planned HCAI System Outage

The HCAI system will be updated to support the transition to the new Guideline.
Insurers and providers should ensure that they successfully complete and submit their forms before 5 p.m. Eastern Daylight Time (EDT) on June 29, 2012, if they are to be processed under the HCAI December 2011 Guideline. The HCAI servers will be taken offline and become inaccessible at exactly 5:01 p.m. EDT on June 29, 2012. HCAI and its DEC will not accept any forms after 5 p.m. EDT on June 29, 2012. Any forms that are not processed by 5 p.m. EDT on June 29, 2012 will be deemed not to have been received by HCAI before July 3, 2012 and will therefore be processed under the new Guideline.  
 
The updated HCAI system will become available at 8 a.m. EDT on July 3, 2012.  At that point, HCAI and its DEC will begin enforcing the new rules for OCF-21 submissions.
 

Authority

The new Guideline is issued pursuant to section 268.3 (1) of the Insurance Act for the purposes of the SABS. 
 

Copies of the HCAI Guideline

A copy of the new Guideline is attached.  The new Guideline is also available on FSCO’s website at www.fsco.gov.on.ca and will be published in a forthcoming edition of The Ontario Gazette.
 

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 email:
 
  Telephone for HCAI Processing: (416) 644-3110
  Email for health facility/provider support: Providersupport@hcaiinfo.ca
  Email for insurer support: Insurersupport@hcaiinfo.ca
 
 
 
Philip Howell
Chief Executive Officer and
Superintendent of Financial Services
June 21, 2012
 

Attachment:            

  1. HCAI Guideline No. 02/12[PDF Document] Size: 339 kb


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