November 10, 2014 - Issue 11
The Financial Services Commission of Ontario (FSCO) has now received service provider licence applications representing over 90 percent of the total dollar volume processed through the Health Claims for Auto Insurance (HCAI) system in the past fiscal year.
Important: Licensed or unlicensed, all HCAI facilities will have to submit OCF-21s
As of December 1, 2014, both licensed and unlicensed service providers will continue to complete and submit the Auto Insurance Standard Invoice (OCF-21) through HCAI. And, insurers will continue to record their adjudication decisions in HCAI for all invoice submissions from licensed and unlicensed service providers.
However, getting reimbursed following submission of the OCF-21 will be different for licensed and unlicensed service providers. Effective December 1, 2014:
- Insurers will pay licensed service providers directly on submitted OCF-21s in accordance with the SABS for goods and services provided on or after December 1, 2014.
- Insurers will be prohibited from paying unlicensed service providers directly on OCF-21s for goods and services provided on or after December 1, 2014.
FSCO anticipates that once proposed regulations are passed, unlicensed service providers will have to provide a hard copy of the HCAI-validated OCF-21 to the claimant for submission to his/her insurer, and collect payment directly from the claimant.
In the coming weeks, FSCO will publish a new HCAI Guideline which sets out these and other requirements.
FSCO embarking on consumer awareness campaign about service providers
This November, FSCO will begin a province-wide consumer awareness and education campaign about Service Providers. The campaign will help consumers to:
- Understand why FSCO is regulating service providers’ business and billing practices.
- Recognize the differences between licensed and unlicensed health service providers.
- Find a licensed health service provider near them.
- Understand what information and documents to get from their service providers.
Regional service provider information sessions
Thank you to all those who attended FSCO’s Windsor and Thunder Bay service provider information sessions on October 15 and 20, 2014.
FSCO’s application review process takes time
Send in your application soon. The due diligence involved in FSCO’s assessment of an application takes time and includes criminal background checks.
FSCO’s service guarantee expired
Applications submitted after August 31, 2014, cannot be guaranteed a licensing decision by December 1st. Although FSCO continues to review applications as quickly as possible, service providers applying now for a licence may not have a licensing decision until the new year.
Where to go for more information
For more information about service provider licensing:
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.
Toll free: 1-800-668-0128