Canadian Underwriter

FSCO posts Health Claims for Auto Insurance (HCAI) Rollout Guideline

April 1, 2007   by

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The Financial Services Commission of Ontario (FSCO) has released its Health Claims for Auto Insurance (HCAI) Rollout Guideline, which includes, among other things, revised accident benefit claims forms and a Central Processing Agency (CPA), an agent designated to receive accident benefit claims forms on behalf of insurers.

“The HCAI Rollout Guideline currently applies only to participating insurers and health care providers,” FSCO noted in an online posting on its Web site. “Companies, health care providers and facilities that have not signed up to participate in the HCAI Rollout will continue to use the standard methods of forms delivery set out in the SABS.”

But by Feb. 1, 2008, FSCO says, “all insurers and health care providers will be required to participate in the HCAI system. At that time, an amended version of the Guideline will be issued to reflect the requirement.”

In a nutshell, the HCAI Rollout Guideline enables the transmission of certain accident benefit claims forms between health care providers and insurers by way of the CPA. Insurers have paid just less than Cdn$20 million for the development of the HCAI process, which will help government, health care providers and insurers to monitor patterns in the health care claims process.

In addition to receiving forms, the CPA will confirm that forms are completed and then make this information available to the insurers to whom they are addressed. The CPA will also enable insurers to communicate claims approval and payment decisions to health care providers.

Health care providers or facilities that wish to submit and receive information through the CPA must first enroll with the CPA and agree to specific terms and conditions. The terms and conditions deal with confidentiality, security, liability, access and data integrity.

In addition, the Professional Services Guideline has been revised to reflect a change in the maximum fees payable for the electronic submission and completion of the Treatment Plan (OCF-18) and the Application for Approval of an Assessment or Examination (OCF-22) to the CPA. All other fees set out in the Professional Services Guideline remain unchanged.

Additional information on the HCAI system and enrollment in the CPA can be found at or by calling 1-888-HCAI123 (1-888-422-4123)

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