New regulatory developments affecting service providers

As businesses and their Principal Representatives prepare to submit their service provider licence applications to the Financial Service Commission of Ontario (FSCO) starting May 1, 2014, they need to be aware of new regulatory developments, which provide important information concerning:

 

FAQ: Do I need a licence?

FAQ: What is a “service provider”?

FAQ: What is a “Principal Representative”?

 

 

New regulatory developments

 

Here is a summary of the most recent regulatory developments affecting service providers. Visit Ontario E-Laws [New Window] for more detail.  

Licence application start date and licence enforcement date

FSCO will be accepting service provider licence applications starting May 1, 2014. Licences will be required November 1, 2014.

 

Listed Expenses and Licence Applicability [New Window]

 

This regulation sets out the type of expenses related to Statutory Accident Benefits covered by the licensing system, and the time period when a licence is required for a service provider to receive direct payment from an insurer.

 

“Listed expenses” are expenses for the goods and services covered by the Health Claims for Auto Insurance Guideline [PDF Document] Size: ## kb. These listed expenses are the assessments, examinations, reports, forms plans, goods and services that need to be billed through Health Claims for Auto Insurance (HCAI) [New Window] on an Auto Insurance Standard Invoice (OCF-21). A service provider will need a licence to submit invoices through HCAI and to receive direct payment from auto insurers for these listed expenses. An insurer will not be allowed to pay a service provider for listed expenses if the business does not hold a licence as of November 1, 2014.

 

In order to submit invoices through HCAI and receive direct payment from auto insurers for listed expenses, a service provider must have a valid licence at two points in time:

 

  1. The date when the assessment, examination, report, form, plan, good or service was provided (as indicated by the “date of service” on the OCF-21 form); and
  2. The date when the invoice (OCF-21) is received by HCAI.

 

Service providers who do not have a licence will still be able to submit invoices for listed expenses through HCAI for dates of service that are before November 1, 2014.

 

On November 1, 2014, service providers who do not have a licence can seek payments directly from claimants who, in turn, can seek reimbursement from their insurer.

 

Business Standards [New Window]

 

To maintain their licence, service providers will be expected to meet prescribed business standards [New Window]. This means that service providers will be expected to:

 

  • provide certain information to insurers upon request within a given timeframe;
  • comply with proper invoicing practices;
  • implement processes to periodically review documents submitted to insurers;
  • observe record retention requirements;
  • establish and implement policies and procedures to ensure compliance;
  • report important changes in the business to FSCO; and
  • submit an Annual Information Return (AIR) to FSCO.

Suspension/Revocation/Surrender [New Window]

 

The licensing regulation sets out qualifications for a licence and circumstances when a licence may be revoked, suspended or surrendered. FSCO may initiate a compliance evaluation at any time, randomly or based on information obtained from various sources, such as the licence application, the Annual Information Return, or from complaints. Based on the outcome of an evaluation, the Superintendent may take enforcement action.

 

For example, the Superintendent will have the authority to refuse, suspend, amend or revoke a licence.

 

If a service provider’s licence has been suspended, revoked, or surrendered, the service provider will not be able to submit invoices for listed expenses through HCAI or receive direct payment from auto insurers for listed expenses unless the licence is reinstated.

 

 

More information

 

 

About FSCO

 

FSCO is a regulatory agency of the Ministry of Finance who regulates certain financial services sectors conducting business in Ontario (read more).