FSCO releases new HCAI guideline in time for auto reform implementation

The Financial Services Commission of Ontario (FSCO) released an updated guideline with respect to Health Claims for Auto Insurance (HCAI) to reflect the new Statutory Accident Benefits Schedule effective Sept. 1, 2010.
The Health Claims for Auto Insurance September 2010 Guideline – Superintendent’s Guideline No. 07/10 mandates the transmission of certain accident benefit forms – OCF 18, 21 and 23 – between health care providers and insurers by way of a central processing agency (CPA). HCAI will serve as the CPA.
HCAI also enables insurers to communicate claims approval and payment decisions to health care facilities, the FSCO bulletin says.
The new Guideline also:
• states that all insurers, and those health care facilities named on FSCO’s web site, are subject to the new guideline;
• describes how to deliver documents to the CPA;
• includes rules governing attachments and when documents are considered to be received by the CPA;
• includes rules dealing with the deemed receipt of documents;
• includes coding information required to complete specified forms and documents; and
• provides other technical details regarding HCAI and the CPA.
The new guideline will replace the Health Claims for Auto Insurance 201 Rollout Guideline – Superintendent’s Guideline No. 01/10.