The Financial Services Commission of Ontario (FSCO) has released a bulletin which will revise the guidelines for the Health Claims for Automobile Insurance (HCAI) system, effective December 1, 2011.

These changes include:

• Health care professionals will only be able to invoice the insurer at the completion of their treatment plan, or once every 30 days if the treatment extends beyond a month;
• A statement that repeated and/or deliberate submission of duplicate invoices and invoices for non-approved goods and services may be considered by HCAI to constitute a contravention of HCAI’s terms and conditions and result in suspension or revocation of the health care provider’s access to HCAI;
• A section on recordkeeping has been added to the new Guideline as an extension of Property and Casualty Auto Bulletin A-02/11, Insurer Rights and Responsibilities to Challenge Questionable or Abusive Claims; and
• Changes have been made to the Appendix 3 Validation Rules in order to provide more clarity for the user.

The bulletin also notes that, effective July 1, 2012, FSCO will issue an amended OCF-21 form that will provide 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 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.

To read the FSCO Bulletin in full, click here.