Ontario’s new electronic health claims processing system, HCAI, to be re-launched on May 22

Having been in dry-dock for repairs since April 2008, Ontario’s new Health Claims for Auto Insurance (HCAI) electronic claims processing system will be officially re-launched on May 22, 2010.
The re-introduction of HCAI is just in time for Ontario’s auto reforms, which are to be implemented on Sept. 1, 2010.
HCAI will be embedded with the new business rules required to process claims as of the Sept. 1 implementation of the Ontario auto reforms. The government is planning to conduct a substantive review of the province’s auto insurance claims forms in 2011, a timeline selected to accommodate the re-launch of HCAI.
IBC reported that all Ontario insurers have already adopted HCAI as of Apr. 1, 2010.
HCAI allows health care providers to submit claims forms and treatment plans to insurers electronically, as well as to receive from insurers real-time confirmation of receipt of forms submissions.
In addition, it allows health care providers real-time access to adjudication decisions by insurance adjusters.
The system also automatically validates information fields, ensuring that the forms are filled out properly and completely. This helps to eliminate games of phone or fax tag between health care providers and insurers, thus creating quicker access to treatment for claimants.
Insurers wishing to know more about the new system and process can find role-based training in print and video formats on the Web site: www.hcaiinfo.ca.
At a media briefing to announce the new voyage of HCAI, the Insurance Bureau of Canada (IBC) declined to place a figure on the amount it has cost thus far to build HCAI. (As of 2007, IBC pegged the cost at around $20 million).
“The experience of insurers since the re-launch of HCAI has illustrated to insurers the tremendous value of HCAI,” said Randy Bundus, vice president of operations and general counsel of IBC. “I’ve heard nothing but positive responses by every insurer that’s used it that it’s going to make their world a far better place than it was in the paper world.
“I’ve not heard one complaint about the cost of HCAI.”
At the request of insurers, in March 2008, Ontario’s insurance regulator pulled the plug on the insurers’ mandatory use of HCAI when insurers encountered “technical problems” that caused ripple effects in their claims adjustment processes.
Since then, IBC has re-introduced the project in phases. It started a pilot project in September 2009 that ended in February 2010.
More than 47,000 Ontario claims forms were submitted electronically through the HCAI system in April 2010, the IBC says. This volume represents 60% of the anticipated total when the project is fully deployed.
In total, insurers approved $12 million in claims in April 2010.
To date, more than 800 health care facilities have adopted HCAI, representing more than 8,600 users. Ontario’s regulator will be overseeing a phased re-introduction of mandatory participation of health care providers in HCAI over 2010.
IBC predicts that when fully deployed, HCAI will support in excess of 5,000 health care facilities.