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FSCO introduces new HCAI guidelines to help insurers reconcile health care invoices


June 29, 2012   by Canadian Underwriter


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The Financial Services Commission of Ontario (FSCO) has released a new Health Claims for Auto Insurance (HCAI) July 2012 Guideline – Superintendent’s Guideline No. 02/12, intended to help insurers reconcile health care invoices.

HCAI is an electronic system for transmitting auto insurance claim forms between insurers and health care facilities in Ontario.

“FSCO has received feedback from stakeholders regarding difficulty reconciling the Auto Insurance Standard Invoice (OCF-21) to the appropriate Treatment and Assessment Plans (OCF-18) and/or Treatment Confirmation Forms (OCF-23),” FSCO notes in an online bulletin.

“To address this issue, the new guideline provides that the ‘Plan Number’ of the OCF-18 or OCF-23 to which the OCF-21 refers is a mandatory field.

“This is the unique ‘Document Number’ generated by the HCAI system when the OCF-18 or OCF-23 to which the OCF-21 refers is submitted, and will enable insurers to properly reconcile invoices.”

FSCO also plans to introduce new amendments to the OCF-21, OCF-18 and OCF-23 forms in November 2012. The amendments will not change the current wording of the forms, but rather introduce two new mandatory additional data fields intended to collect more information about Minor Injury Guideline (MIG) claims.

The two new mandatory fields will identify “the date that the MIG treatment block commenced and the profession(s) of the health care provider(s) who provided the treatment,” FSCO notes. “In addition, use of the [amended] OCF-21C will become mandatory for billing all amounts applicable under the MIG.”

The complete FSCO bulletin can be found at:

http://www.fsco.gov.on.ca/en/auto/autobulletins/2012/Pages/a-02-12.aspx