Service Providers: Operating in the new regime effective December 1, 2014

November 30, 2014 - Issue #12

New regime = no change for licensed service providers

 

On December 1, 2014, service providers licensed by the Financial Services Commission of Ontario (FSCO) will continue to conduct business in the same fashion.
 
Licensed service providers will continue to submit all forms through HCAI for goods and services provided on and after December 1st. And, licensed service providers will continue to be paid directly by insurers.
 
New flexibility in OCF-21 submission schedule: On and after December 1, 2014, licensed service providers can submit OCF-21s once per calendar month as opposed to once every 30 days.

Service providers without a licence from FSCO

 
Under the new regime, claimants will still be able to seek treatment from unlicensed service providers without any impact on their ability to receive goods and services under the statutory accident benefits scheme.
 
However, Service providers without a FSCO license will still need to be registered with Health Claims in Auto Insurance system (HCAI). And, they will need to continue to submit all OCFs through HCAI for goods and services provided.
 

Unlicensed service providers will have an extra step when dealing with the OCF-21 form.

 
Insurers will be prohibited from paying unlicensed service providers directly on OCF-21s for goods and services provided on or after December 1, 2014. Instead, unlicensed service providers must seek payment from the claimant.
 
The unlicensed service provider must provide a printed copy of the HCAI-validated OCF-21 to the claimant. In turn, the claimant will submit the OCF-21 to his/her insurer for reimbursement. 
 
Service providers without a licence should also be aware that insurers will be permitted to recommend a licensed service provider to claimants. Insurers can also promote the benefits of getting treatment from a licensed service provider with respect to the payment process.
 

Licensed AND unlicensed service providers – before or on Nov. 30, 2014

 
For approved services provided on or before November 30, 2014, both licensed and unlicensed service providers must continue to submit OCF-21s through HCAI; they can be paid directly by an insurer for approved services.

Notes on the new HCAI Guideline

 
OCF-21 Record keeping:  An unintended change occurred in the drafting of the revised HCAI Guideline issued November 24, 2014. 
 
The new guideline contains rules on record keeping pertaining to the submitting of the OCF-21 (page 7). The new guideline states that the requirement to keep an original paper version or electronic true copy of the submitted OCF-21 must include the signature of the regulated health professional. This change was not intended. 
 
The requirement remains as dictated by the Superintendent-approved OCF-21, i.e. that a provider or authorized signatory must sign the form.  It is this signature that must be kept on file.
 
Attendant Care Benefits: Effective December 1, 2014, Attendant Care is no longer subject to the HCAI Guideline and is not specified for the purposes of SABS section 49. OCF-21s related to Attendant Care costs should not be submitted through HCAI.
 
See FSCO's new HCAI Guideline, released November 24, 2014, which sets out this provision and other requirements.
 

Finding a licensed service provider

 
Beginning December 1st, FSCO will maintain a new online registry of service providers. The registry will provide up-to-date information on active and inactive service providers including facility addresses, licence status, licence conditions and the names of principal representatives.
 
The registry will be searchable and updated in real-time. Access the new public registry on FSCO’s website at www.fsco.gov.on.ca.

Licence pending?

 
If you are a service provider awaiting a licence decision from FSCO after December 1, 2014, you are not permitted to receive direct payment from an insurer for goods and services you have provided after November 30, 2014 until the effective date of your licence.

Just now submitting your licence application?

 
FSCO continues to review new applications as quickly as possible. However, service providers applying now should be aware that they may not have a licensing decision until 2015. This is because FSCO conducts a thorough assessment of an application and includes criminal background checks.
 

Future eNewsletter topics

 
  • Complaint handling
  • Ongoing compliance

Where to go for more information

 
For more information about service provider licensing:

Need help?

 
FSCO is committed to promptly responding to service provider inquiries, and posts answers to frequently asked questions on its website. If you still need help, contact FSCO.
 
416-250-7250
Toll free: 1-800-668-0128
TTY: 1-800-387-0584