Additional Requirements for Health Claims for Auto Insurance and Changes to Certain Accident Benefit Claim Forms

 
Bulletin
       No. [A-04/12]
[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 highlighting changes regarding the use of accident benefit claim forms in the Health Claims for Auto Insurance (HCAI) system, and revisions to certain forms.  These changes were previously announced in Bulletin No. A‑02/12 dated June 21, 2012.
 
These changes apply to documents that are delivered on or after November 1, 2012, regardless of the date of the accident to which they relate.
 

Additional Requirements 

 
The HCAI system collects and provides de-identified data to the Insurance Bureau of Canada’s (IBC) Health Claims Database regarding auto insurance health claims, which helps 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.
 
With this Bulletin, FSCO is issuing a revised Auto Insurance Standard Invoice (OCF-21) form.  The revised OCF-21 includes two new mandatory data fields, in which the date that each MIG treatment Block commenced, and the profession(s) of the health practitioner(s) who provided the treatment, are to be identified.

In addition, use of the OCF-21C is mandatory for billing all amounts under the MIG. The OCF-21B and the Treatment and Assessment Plan (OCF-18) are no longer approved for use with MIG codes.
 

Revised Accident Benefit Forms

 
The revised OCF-21 form reflects the mandatory requirement for the completion of the “Plan Number” field, in the manner specified in the Health Claims for Auto Insurance July 2012 Guideline (Superintendent’s Guideline No. 02/12), which became effective July 1, 2012.
 
In addition, the OCF-21 has been revised to emphasize specific language appearing above the signature boxes in the form through bolding and increased font sizes. These changes have been made to raise the awareness of those individuals signing the form of their responsibility and accountability in doing so.  The same changes have been made to the OCF-18 and to the Treatment Confirmation Form (OCF-23). The current wording in these forms has not changed.  
 
Earlier versions of the OCF-18, OCF-21 and OCF-23 are no longer approved for use on or after November 1, 2012.
 

Planned HCAI System Outage

 
The HCAI system will be updated to support these new rules.
 
Insurers and providers should ensure that they successfully complete and submit their forms before 5 p.m. Eastern Daylight Time (EDT) on October 31, 2012, if they are to be processed under the existing rules.  The HCAI servers will be taken offline and become inaccessible at exactly 5:01 p.m. EDT on October 31, 2012.  HCAI and its Data Entry Centre (DEC) will not accept any forms after 5 p.m. EDT on October 31, 2012.  Any forms that are not processed by 5 p.m. EDT on October 31, 2012 will be deemed not to have been received by HCAI before November 1, 2012, and therefore will be processed under the new rules.  The updated HCAI system will become available at 8 a.m. EDT on November 1, 2012.  At that point, HCAI and its DEC will begin enforcing the new rules for all submissions.

 

Copies of the Revised Forms

 
Copies of the revised forms are attached and are also available on FSCO's website at www.fsco.gov.on.ca.
 

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:
 
 
 
Philip Howell
Chief Executive Officer and
Superintendent of Financial Services
October 5, 2012
 

Attachments:              

  1. OCF-18, OCF-21, OCF-23 approved for use on or after November 1, 2012


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