Issue No. 4, March 2014
Businesses that wish to invoice auto insurers through Health Claims for Auto Insurance (HCAI) and be paid directly by auto insurers for specified goods or services provided to Statutory Accident Benefit claimants will need a licence from FSCO. A service provider licence will authorize the business to receive direct payments from auto insurers for specific listed expenses.
A "service provider" is a business or legal entity that provides specified goods or services to Statutory Accident Benefit claimants, for which it submits an invoice (OCF-21) through Health Claims for Auto Insurance (HCAI) in order to receive payment from an auto insurer. Typically, service providers are health and rehabilitation clinics, as well as providers of examinations and assessments.
FSCO will issue service provider licences at the business or legal entity level (e.g. the sole proprietorship, partnership, corporation). This means that only one licence is needed for all facilities, branches or locations operated by a service provider.
FSCO will start accepting licence applications in the spring of 2014, and licences will be mandatory in the fall of 2014.
Will I need a licence?
I work for a facility that submits OCF-21 forms through HCAI and pays me. Do I need a licence?
No. The business or legal entity operating the facility that submits invoices through HCAI will need a licence to continue to receive direct payments from auto insurers.
I only submit OCF-18 and OCF-23 forms through HCAI, and I invoice the claimant directly. Will my business need a licence to do this?
No. Your business can keep submitting OCF-18 and/or OCF-23 forms through HCAI and your business can continue invoicing the claimant directly without a service provider licence. You do not have to be licensed with FSCO to register with and use the HCAI system to submit OCF-18 and OCF-23 forms.
I operate a branch office for a large business. Does my branch need a licence?
No. Only the business would need to be licensed. All of the business' facilities, branches, and locations are covered with one licence. Please forward this eNewsletter to key decision makers of that business.
I'm an "Authorizing Officer". I oversee my facility's billing on the HCAI system. Do I need a licence?
No. Only the business or legal entity that operates the facility will need a licence. Please forward this eNewsletter to key decision makers of that business.
I provide assessment and examination services for a business. Do I need a licence?
No. Only the business or legal entity for which you are conducting those assessments or examinations will need a licence.
I am an individual who provides goods and services to Statutory Accident Benefits claimants. I submit my invoices through HCAI but I do not have a business number. Do I need a licence?
Yes. If you submit OCF-21 forms through HCAI you will need a licence in order to continue to receive payments from auto insurers. When applying for a licence in the spring of 2014, you are considered a sole proprietor.
My business occasionally submits OCF-21 forms through HCAI, but Statutory Accident Benefit claims are not really part of the core business. Do we still need a licence?
Yes. Regardless of how frequently it submits OCF-21 forms through HCAI, the business will need a licence if you wish to continue to receive direct payments from auto insurers.
I am a sole proprietor who occasionally does work for another facility. I have my own HCAI account and handle all of my billing. The facility is completely separate from my billing/payment processes. Do I need a licence?
Yes. If you are operating as a sole proprietor and you independently bill insurers through HCAI outside of the facility business, you will need to be licensed as a service provider in order to continue to receive direct payments from auto insurers for Statutory Accident Benefit claims.
How much is it going to cost?
All applicants will be required to pay an initial (one-time) licence application fee, as well as an annual regulatory fee to cover the costs of regulating their business practices.
FSCO will provide more information about those fees as soon as possible. Please ensure you subscribe to our Service Provider eNewsletters through our subscription centre
to ensure you receive the latest news and updates directly into your inbox. HCAI has kindly agreed to distribute this eNewsletter on FSCO’s behalf, but once FSCO starts accepting licence applications, we will begin using our own distribution lists. Subscribe to be included in FSCO's communications.
There will be important information released soon concerning:
- The application start date;
- The licence enforcement date;
- A clear definition of "listed expenses" (i.e. description of the specific goods and services covered by the service provider licensing);
- Necessary business standards and practices;
- Information concerning licence processes, including suspension, revocation, and surrender of a licence
FSCO is a regulatory agency of the Ministry of Finance and regulates insurance and other financial services sectors conducting business in Ontario (read more).