Health Care Facility | Insurers | Related Initiatives  

OCF-21B Auto Insurance Standard Invoice


The OCF-21B is used to invoice automobile Insurers for the medical and rehabilitation goods and services, assessments and examinations submitted under the OCF-18.

This page will explain step-by-step how to complete each section of the OCF-21B. Additionally, it explains how you can create an OCF-21B directly from a plan, use an OCF-21B to reimburse an Insurer for overpayment/issue a credit, and collect interest owed on outstanding invoices.

Use the side menu to jump to a specific section.

OCF-21B Auto Insurance Standard Invoice


Create an Invoice from a Plan

Creating an invoice from a plan has useful benefits, including the following:

  • It auto-populates certain fields from the submitted plan, such as the Claim Identifier and Parts 1, 2, and 4
  • It auto-populates the plan’s Document Number and links to the plan
  • It makes it easier to view the plan’s treatments and approved amounts
  • It saves times, and
  • It ensures data accuracy

To create an invoice from a plan:

  • Locate and open the submitted plan (OCF-18/23).
  • Click the “Create Invoice” button near the top left of the window, and you will be brought directly into an invoice (OCF-21). (View screenshot)
  • Many of the fields in the OCF-21 will be populated from the submitted plan, including the associated plan’s Document Number.
  • Click on the plan’s Document Number under Part 3: Invoice Details to open and review its contents while completing the OCF-21.

OCF-21B Auto Insurance Standard Invoice


Claim Identifier and Part 1: Applicant Information

OCF-21B: Claim Identifier and Part 1 - Applicant Information

This section contains details about the claim, and information about the Patient. The Applicant (Patient) or Substitute Decision-maker should provide this information. Carefully entering Claim Identifier and Applicant Information is important for matching purposes. View Submitting and Storing forms for more information on matching.  (View screenshot)

Claim Identifier

  1. You must  enter either a claim number or a policy number. Only one of these numbers is required, not both. However, if you have both claim and policy number, it is helpful to insert both.
  2. Enter the date of the accident using the calendar tool, formatted as shown.

Applicant Information

The following fields are mandatory: Date of birth, gender, first and last name, address, city, province, and postal code.

OCF-21B Auto Insurance Standard Invoice


Part 2: Auto Insurer Information

OCF-21B: Part 2 - Auto Insurer Information

This section includes the Patient’s automotive insurer details. The Applicant (Patient) or Substitute Decision-maker should provide this information. (View screenshot)

Remember: All OCF-21s must be submitted via HCAI. Insurers and Independent Adjusters cannot receive the OCF-21 via fax or mail.

  1. Select the insurance company to whom this form will be sent. Use the drop-down list and select from the available companies.
    • Please note: 100% of insurance companies are enrolled and using HCAI. Please be aware that independent adjusting firms will not appear in this drop-down list because they are not licensed insurers. To direct claim forms appropriately, HCFs should determine (typically by asking the patient or the Independent Adjuster) the name of the licensed Insurer that is managing the claim.  
  2. Indicate whether the policy holder is the same person as the Applicant.
    • If the Patient is the person who holds the insurance policy, select “Yes”.
    • If the Patient is not the policy holder, select “No”. For example, a child who has been injured in an accident would likely have coverage under his parents’ policy. In that case, enter the last name of the policy holder.
  3. The last name of the policy holder is mandatory if the policy holder is not the same as the Applicant

OCF-21B Auto Insurance Standard Invoice


Part 3: Invoice Details

OCF-21B: Part 3 - Invoice Details

This section identifies the plan that is associated with this invoice and whether or not this is the first and/or last invoice under this plan. (View screenshot)

  1. If your Facility uses an internal Invoice numbering system, enter it in the Provider Invoice Number. This field is not mandatory and may be left blank. This number will appear in the HCAI worklist and can help you locate an invoice after it has been submitted.
  2. Click “Yes” for First Invoice if your Facility has not previously invoiced the Insurer for the associated Plan.
  3. Click “Yes” for Last Invoice if this is the last invoice to be submitted for the associated Plan.

Previously Approved Goods and Services
This section asks “Is this invoice for goods and services approved on an OCF-18 in HCAI?”

If the goods and services being invoiced are included in an associated Plan, select “Yes” and type in the Plan’s Document Number.

If you do not have the Document Number, select “Yes” and type “exempt” (case sensitive) into the Document Number field.

If you created this Invoice from a Plan, the Document Number will auto-populate.

If your invoice includes goods and services that are not included in an associated Plan, select “No”. This indicates you have selected an exemption from providing a Document Number. FSCO’s HCAI Guideline explains when it is appropriate to request an exemption.

If you are invoicing for services that were proposed on a Plan submitted by a different Facility, enter the document number provided to you by the submitting Facility.

OCF-21B Auto Insurance Standard Invoice


Part 4: Payee Information

OCF-21B: Part 4 - Payee Information

  1. To comply with FSCO’s service provider licence business rules, Part 4 asks, “Is the payee the Health Care Facility?” (View screenshot)
    • If a valid service provider licence was held by the Facility on all dates of service as well as the date of OCF submission, “Yes” may be selected.
    • If the Facility does not have a service provider licence, or did not have a service provider licence at the time the services were provided, select “No”. The Insurer may only pay the Claimant directly. The Claimant must provide a paper print-out of the HCAI-submitted OCF to the Insurer prior to the Insurer adjudicating and issuing a payment.
    • Visit the Service Provider Licensing page for more information about SPL.
  2. During registration, the Facility will have chosen “Yes” or “No” to the question “Payee Field Editable?” If “No” was selected, the ‘Make cheque payable to” field cannot be edited as HCAI has automatically populated the Facility’s name and mailing address in the space provided.
    • If “Yes” was selected, the field next to Make Cheque Payable To must be completed.

OCF-21B Auto Insurance Standard Invoice


Injury and Sequelae Codes

OCF-21B: Injury and Sequelae Codes

Injuries or problems are coded using the standard descriptions from the International Classification of Disease, 10th version, Canadian edition (ICD-10-CA). You can find partial and complete ICD-10-Ca code lists here:

Visit the Coding page or watch the Injury Coding Basics video for more information. Furthermore, call your health professional association to find out if they have developed an injury code list specific to your profession.

Invoices created to bill for services proposed on an OCF-18

  1. Enter the appropriate injury and sequelae codes for the problems responsible for the treatment being invoiced.
  2. To search for a code, click the “…” button. (View screenshot)
  3. List each code only once, regardless of how many Health Professionals will be engaged in treatment.
  4. The first line item should reflect the primary reason or problem that is most responsible for the proposed services.
    • Example:If psychological services are required after a brain injury, the first code listed should reflect the reason that psychology services are being proposed. F07.2 – Postconcussional Syndrome, and then S06 – Concussion.
    • In a case where multiple injuries may be classified as the most significant, list the injury requiring the most services first.

Invoicing for assessment services

  1. If  invoicing for  assessment  services,  enter  the  injury/problem  code(s)  most appropriate for  the claimant based on the assessment findings.
  2. Ifinvoicing prior to the; assessment’s  completion  and  no  impairment  has  yet  been identified, code the problem that instigated the assessment.
    • Example: An  OCF-18 assessment  proposal  was  generated  due  to  an  ongoing  pain  in  the absence of abnormal physical findings.

Questions about coding
If you have questions about which injury code(s) to use, contact your health professional association. HCAI Support do not have medical training and cannot help you select a code.

Common codes

  • Single physical injury – refer to S codes. (e.g. S42.0 – Fracture of clavicle)
  • Multiple injuries and bilateral injuries – refer to T codes (do not list duplicate codes for bilateral injuries).
  • Mental and behavioral disorders – refer to F codes.
  • Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified – refer to R codes.

Adding additional lines for injury/sequelae codes

If more space is required for additional injuries or problem codes, extra lines may be added by clicking the “+” button. (View screenshot)

OCF-21B Auto Insurance Standard Invoice


Reimbursable Goods and Services

OCF-21B: Reimbursable Goods and Services

This section uses CCI (Canadian Classification of Interventions) codes or GAP (Goods, Administration, and Other) codes, as well as Unit Measures and Provider Type codes. You can find partial and complete code lists here:

If more space is required for additional goods and services, extra lines may be added.

  • Select the number of lines you wish to add using the “Add more items” dropdown list just above the “Calculate cost from rates” button, then click “Go”.

You can also visit the Coding page or watch the Treatment Coding Basics video for more information.

View screenshot of section.

Date service rendered

  1. All dates that the Patient attended for treatment should be listed. Dates should be formatted YYYY/MM/DD, or the calendar function may be used.

Code

  1. Enter the intervention code by typing it directly into the field, or use the code search utility by clicking the “...” button next to the “Code” field.
  2. The “Search Goods and Services Codes” window opens. Select either “CCI” or “GAP”. (View screenshot)

    • CCI are international standard codes for health interventions.
    • GAP codes were developed by Insurance Bureau of Canada with the help auto insurers and health care providers, and can be used for services that are not well reflected in the CCI, such as:
      • Administrative services such as travel time and mileage
      • Pre-claim examination
      • Goods and Supplies
      • Health Provider Initiated Examination & Insurer Initiated Examination, including  Attendant care, Catastrophic, Disability (Pre 104 weeks and Post 104 weeks), Combined (MedRehab and Disability), and MedRehab
      • Telephone consultation with other Health Providers
  3. Once you have selected CCI or GAP, the Section drop-down menu will populate.
  4. Pick a Section in order to have the Intervention drop-down menu populate.
  5. Pick an Intervention in order to have the Group drop-down menu populate.
  6. Select a Group and hit the “Search” button.
  7. The search results appear. To add a code to your plan, click the “Add” button.

Attribute

  1. In addition to the CCI codes, health care services can be further specified with “Attribute Codes”. These codes are used to indicate how the service was delivered, such as the number of views in an X-ray study.
    • The absence of attribute codes means that the service was rendered directly (in person) to one individual by one individual Provider and required continuous attendance.
    • Refer to page 2 of Appendix B for more information about Attributes.

Provider Reference

  1. To select the Provider who delivered care, click on the “...” button to open the Select a Provider window. (View screenshot)
  2. Use the drop-down menu to select the Provider. If more than one Provider delivered care, list only the one who was most responsible for each visit and who will be most likely to be listed on the invoice.
  3. If the Provider has a default hourly rate assigned, that figure will also appear.
  4. Use the Profession drop-down menu to select the applicable profession if the Provider has more than one assigned in HCAI.

To insert the same Provider for multiple line items (View screenshot)

  1. Complete all fields except for “Provider Reference”.
  2. Check the box to the left of each completed line item that you wish to assign the same Provider(s) to.
  3. Click the “Apply Providers” button and select the name of the Provider(s) from the dropdown list.

Quantity/Unit measure

  1. Enter the quantity and unit measure of service that will be provided during a single treatment visit/session. For example:
    • 15 minutes = 0.25 HR
    • 1 procedure = 1 PR
    • 1 good (such as a back support) = 1 GD
    • 10 km = 10 KM
    • 1 session = 1 SN
    • Click here to view more about Unit Measures (PDF)

Cost

  1. HCAI allows Facilities to enter a default hourly rate for each Provider under the Facility Management screen. This can be used to calculate the cost per line of treatment. If the Measure assigned is HR and the Provider has an assigned hourly rate, the cost will be calculated automatically based on the Provider’s default hourly rate. Click here to learn how to assign an hourly rate to a Provider.
  2. You may click on the “Calculate costs from rates” button to override the value in the Cost field for any measure of HR or KM and assign the default rates.
  3. If the Provider selected does not have a default hourly rate assigned, or you need to use a different rate, enter the value in the Cost field.
  4. Be sure to report the cost per service as the service is described in the line.
    • For example: 15 minutes of massage or 0.25 HR by a Massage Therapist = 25% of the RMT’s hourly fee.

Facilities may charge fees in excess of the Superintendent’s Professional Fee Guideline, but Insurers are not required to pay fees that exceed that Guideline.

Add more items
To add lines for additional goods and/or services, select the number of lines you wish to add using the “Add more items” dropdown list just above the “Calculate Costs From Rates” button, then click the “GO” button.

Prior Balance, Overdue Amounts and Interest Charges
If the Facility has submitted an invoice prior to the current invoice, but it has not been fully paid, you may document the outstanding amount and associated interest on this invoice. (View screenshot)

  1. Insert the Prior Balance – which is the amount of the previous invoice.
  2. Insert thePayment Received from Auto Insurer.
  3. Insert the Overdue Amount* from the previous invoice.
  4. Insert the Interest as calculated on the overdue amount.

* The overdue amount, prior balance, and payment received from auto Insurer will not be added to the Auto Insurer Total on this new invoice. Only the interest amount will be added to this invoice. The previous invoice is still effective and amounts from prior invoices should not be added to new invoices.

OCF-21B Auto Insurance Standard Invoice


Other Insurance

OCF-21B: Other Insurance

  1. Select “Yes” or “No” to establish whether there is other insurance coverage. (View screenshot)
    • If “Yes” is selected, enter the information underneath Other Insurer 1 and, if applicable, Other Insurer 2. These fields are not mandatory and can be left blank if you do not have the information.

Other Insurance (for goods and services on this invoice) (View screenshot)

  1. If amounts are payable by another insurer, enter the amounts in the category of service. Do not use a negative (-) sign for these amounts. These amounts will be deducted from the amount owed by the Insurer.
  2. When the category “Other” is used, specify the type of services covered (e.g. dental, psychological, optometric).
  3. To enter amounts previously identified for payment by another Insurer but subsequently ruled ineligible, select “Yes” for the question, “Do you want to claim any amounts not reimbursed by other insurance sources?”
    • Enter the amounts for the corresponding Insurer in the section that appears.
  4. Click the “Calculate” button to see the total for each line.

OCF-21B Auto Insurance Standard Invoice


Totalling

This section sums up the costs outlined on this invoice. It is possible to invoice for amounts greater than or less than those proposed on a plan, but the Insurer may request an explanation.

Sub-total: Sum of the cost of all amounts entered in Reimbursable Goods and Services section.

Minus MOH: Sum of all Ministry of Health and Long-Term Care amounts (this amount is taken from the “Charged Services” MOH line). Amounts paid to you or expected to be paid to you are subtracted from the amount billed to the Auto Insurer. Amounts that you previously stated were available to you but were unable to collect will be added to the Auto Insurer’s invoice.

Minus Other Insurer (1 + 2): Sum of all amounts received or payable to you from other Insurers. This amount is taken from the “Charged Services” of Other Insurer 1 and 2. Amounts paid to you or expected to be paid to you are subtracted from the amount billed to the Auto Insurer. Amounts that you previously stated were available to you were unable to collect will be added to the Auto Insurer’s invoice.

Tax: Sum of taxable amount for any goods or services subject to the Harmonized Goods and Services Tax (13%) or other applicable tax. 

Prior Balance*: Enter Prior Balance (the Auto Insurer Total from your last invoice).

Payment Received from Auto Insurer: Any additional payments received. 

Overdue Amount*: Subtract payments received since your last invoice to calculate the overdue amount.

Interest*: Enter the interest owing as a result of the overdue amount.

Auto Insurer Total: Sum of all amounts in this section.

*Prior Balance, Overdue Amount and Interest are used as the basis for interest charges that have accumulated and can be calculated into the Auto Insurer Total for this invoice. Only the interest charges will be calculated into the total payable by the Auto Insurer.

Calculating Prior Balance, Overdue Amounts and Interest Charges
If the Facility has submitted an invoice prior to the current invoice, but it has not been fully paid, you may document the outstanding amount and associated interest on this invoice. (View screenshot)

  1. Insert the Prior Balance – which is the amount of the previous invoice.
  2. Insert the Payment Received from Auto Insurer from the previous invoice.
  3. Insert the Overdue Amount* from the previous invoice.
  4. Insert the Interest as calculated on the overdue amount.

*The overdue amount will not be added to the Auto Insurer Total on this new invoice. Only the interest amount will be added to this invoice. The previous invoice is still effective and amounts from prior invoices should not be added to new invoices.

OCF-21B Auto Insurance Standard Invoice


Additional Information

OCF-21B: Additional Information

Space is available for comments if there is a need to provide the Insurer additional explanations/clarifications. There is a limit of 500 characters in the comments field. If more space is needed, use Tab 5. (View screenshot)

OCF-21B Auto Insurance Standard Invoice


Additional Comments

OCF-21B: Additional Comments

The Additional Comments section allows the facility to offer additional information about the Applicant, their injuries, care, treatment, response to treatment, or anything else that will help the Insurer understand the Applicant story. (View screenshot)

  1. You can cut and paste plain text—from a Word document, for example—but you cannot copy and paste complex tables, charts, or images.
    • There is a limit of 20,000 characters.
  2. If you are sending attachments to the Insurer, check off the box next to “Attachments being sent, if any”. Then use the space to describe the attachment. This tells the adjuster not to adjudicate the form until they have received the documents you are sending.
    • If you’d like to submit an attachment as part of the OCF, you cannot embed it into the OCF. Items like PDF files, Excel files, or Word documents must be faxed or mailed directly to the Insurer.
  1. If you’d like to save the OCF as a Draft,  you can click “Save”. A yellow bar across the top will indicate that your form has been saved successfully. (View screenshot)
  2. If you are ready to submit your OCF, click “Submit”. The successful submission window will appear. A unique HCAI document number is generated. This number can be used to track this form.   Insurance adjusters can also track this form in their system using this document number. (View screenshot)
  3. To print the submitted OCF, click the “Print” button. The HCAI document number will be displayed on the printed form.

OCF-21B Auto Insurance Standard Invoice


Process Overpayments or Credit

Occasionally, a Facility may wish to reimburse an Insurer for overpayment or to issue a credit. You may create a single invoice for the overpayment/credit, or process the overpayment/credit with other goods and services on an invoice.

  1. If you are creating a single invoice only for the overpayment/credit, create the OCF-21B either from a plan or from scratch. When you reach the Reimbursable Goods and Services section, enter one line item. The amount entered under “Cost” for the line item should be 0.00. (View screenshot)
  2. If you are processing the overpayment/credit with other goods and services, skip the step above and begin at Step 3, below.
  3. Go to the Other Insurance section, in Tab 4 of the OCF-21B.
  4. Select the button labeled “Yes – There is other insurance coverage…..”
  5. In the ‘Other Insurer 1’ section, enter the name of the auto insurer in the Other Insurer Name box. (View screenshot)
  6. Go to Part 9: “Other Insurance (for goods and services on this invoice)” and enter the amount for repayment in the Insurer 1 row, in the column labeled **Other Service.
  7. In the box labeled “**Other Service Type Specified”, write in the reason for the credit. You may, for example, choose to write “Overpayment by insurer” or “Overpayment/Credit of [xxx]” in this box.
  8. Go to the Totalling section.
  9. Click the “Calculate” button. The credit amount will be displayed in the “Proposed” column within the “Minus Other Insurer (1+2)” field.
  10. Submit the form.

OCF-21B Auto Insurance Standard Invoice


Collect Interest Owed on Outstanding Invoices

The SABS S.51 authorizes payment of interest on overdue amounts, for plans that have been approved by insurers and invoiced more than 30 days ago. This can be done via HCAI.
To charge interest on outstanding amounts owed to your Facility using, the process depends on whether the patient is still receiving services at your clinic or not.

If the claimant is still attending treatment
When preparing the next invoice for a patient still attending treatment, we recommend adding the interest owing to the next invoice, in the Totalling section.

The Totalling section allows you to outline the Prior Balance, the Payment Received by Auto Insurer, the Overdue Amount, and the Interest. When you press the “Calculate” button, only the interest charge will be added to the total amount proposed to be payable by the Insurer on this new invoice. (View screenshot) for an example.

If the claimant is discharged
If you have discharged the claimant and no further invoices are to be submitted, you can prepare a new invoice only for the interest amount as follows: (View screenshot)

  • Create an invoice from the plan on which interest is owing. This way, the interest invoice will be linked to the plan for which payment is outstanding.
  • Enter only one item in Tab 3 under Reimbursable Goods and Services. This is because HCAI requires at least one line item. The cost of the line item should be 0.00.
  • In the Totalling section, enter the information about the outstanding amount and add the interest charges.
  • Go to the Additional Comments section on Tab 5, and enter a note explaining that this invoice is to charge interest on the outstanding balance for this treatment plan.
  • Press the “Save” button to save a draft of this invoice for future use, if you wish.
  • Submit the form.

The Insurer will now have two distinct invoices for the outstanding plan: the one that was submitted originally, and the one charging interest.

Please note: To collect on outstanding invoiced amounts (rather than interest), you may not submit duplicate invoices. This should instead be done by means of a “statement”. The statement is not an OCF and should be sent by fax or mail, not submitted through HCAI.

OCF-21B Auto Insurance Standard Invoice


The OCF-21B is used to invoice automobile Insurers for the medical and rehabilitation goods and services, assessments and examinations submitted under the OCF-18.

This page will explain step-by-step how to complete each section of the OCF-21B. Additionally, it explains how you can create an OCF-21B directly from a plan, use an OCF-21B to reimburse an Insurer for overpayment/issue a credit, and collect interest owed on outstanding invoices.

Jump to:

Create an Invoice from a Plan

Creating an invoice from a plan has useful benefits, including the following:

  • It auto-populates certain fields from the submitted plan, such as the Claim Identifier and Parts 1, 2, and 4
  • It auto-populates the plan’s Document Number and links to the plan
  • It makes it easier to view the plan’s treatments and approved amounts
  • It saves times, and
  • It ensures data accuracy

To create an invoice from a plan:

  • Locate and open the submitted plan (OCF-18/23).
  • Click the “Create Invoice” button near the top left of the window, and you will be brought directly into an invoice (OCF-21). (View screenshot)
  • Many of the fields in the OCF-21 will be populated from the submitted plan, including the associated plan’s Document Number.
  • Click on the plan’s Document Number under Part 3: Invoice Details to open and review its contents while completing the OCF-21.

Claim Identifier and Part 1: Applicant Information


This section contains details about the claim, and information about the Patient. The Applicant (Patient) or Substitute Decision-maker should provide this information. Carefully entering Claim Identifier and Applicant Information is important for matching purposes. View Submitting and Storing forms for more information on matching.  (View screenshot)

Claim Identifier

  1. You must  enter either a claim number or a policy number. Only one of these numbers is required, not both. However, if you have both claim and policy number, it is helpful to insert both.
  2. Enter the date of the accident using the calendar tool, formatted as shown.

Applicant Information

The following fields are mandatory: Date of birth, gender, first and last name, address, city, province, and postal code.

Part 2: Auto Insurer Information


This section includes the Patient’s automotive insurer details. The Applicant (Patient) or Substitute Decision-maker should provide this information. (View screenshot)

Remember: All OCF-21s must be submitted via HCAI. Insurers and Independent Adjusters cannot receive the OCF-21 via fax or mail.

  1. Select the insurance company to whom this form will be sent. Use the drop-down list and select from the available companies.
    • Please note: 100% of insurance companies are enrolled and using HCAI. Please be aware that independent adjusting firms will not appear in this drop-down list because they are not licensed insurers. To direct claim forms appropriately, HCFs should determine (typically by asking the patient or the Independent Adjuster) the name of the licensed Insurer that is managing the claim.  
  2. Indicate whether the policy holder is the same person as the Applicant.
    • If the Patient is the person who holds the insurance policy, select “Yes”.
    • If the Patient is not the policy holder, select “No”. For example, a child who has been injured in an accident would likely have coverage under his parents’ policy. In that case, enter the last name of the policy holder.
  3. The last name of the policy holder is mandatory if the policy holder is not the same as the Applicant

Part 3: Invoice Details


This section identifies the plan that is associated with this invoice and whether or not this is the first and/or last invoice under this plan. (View screenshot)

  1. If your Facility uses an internal Invoice numbering system, enter it in the Provider Invoice Number. This field is not mandatory and may be left blank. This number will appear in the HCAI worklist and can help you locate an invoice after it has been submitted.
  2. Click “Yes” for First Invoice if your Facility has not previously invoiced the Insurer for the associated Plan.
  3. Click “Yes” for Last Invoice if this is the last invoice to be submitted for the associated Plan.

Previously Approved Goods and Services
This section asks “Is this invoice for goods and services approved on an OCF-18 in HCAI?”

If the goods and services being invoiced are included in an associated Plan, select “Yes” and type in the Plan’s Document Number.

If you do not have the Document Number, select “Yes” and type “exempt” (case sensitive) into the Document Number field.

If you created this Invoice from a Plan, the Document Number will auto-populate.

If your invoice includes goods and services that are not included in an associated Plan, select “No”. This indicates you have selected an exemption from providing a Document Number. FSCO’s HCAI Guideline explains when it is appropriate to request an exemption.

If you are invoicing for services that were proposed on a Plan submitted by a different Facility, enter the document number provided to you by the submitting Facility.

Part 4: Payee Information


  1. To comply with FSCO’s service provider licence business rules, Part 4 asks, “Is the payee the Health Care Facility?” (View screenshot)
    • If a valid service provider licence was held by the Facility on all dates of service as well as the date of OCF submission, “Yes” may be selected.
    • If the Facility does not have a service provider licence, or did not have a service provider licence at the time the services were provided, select “No”. The Insurer may only pay the Claimant directly. The Claimant must provide a paper print-out of the HCAI-submitted OCF to the Insurer prior to the Insurer adjudicating and issuing a payment.
    • Visit the Service Provider Licensing page for more information about SPL.
  2. During registration, the Facility will have chosen “Yes” or “No” to the question “Payee Field Editable?” If “No” was selected, the ‘Make cheque payable to” field cannot be edited as HCAI has automatically populated the Facility’s name and mailing address in the space provided.
    • If “Yes” was selected, the field next to Make Cheque Payable To must be completed.

Injury and Sequelae Codes


Injuries or problems are coded using the standard descriptions from the International Classification of Disease, 10th version, Canadian edition (ICD-10-CA). You can find partial and complete ICD-10-Ca code lists here:

Visit the Coding page or watch the Injury Coding Basics video for more information. Furthermore, call your health professional association to find out if they have developed an injury code list specific to your profession.

Invoices created to bill for services proposed on an OCF-18

  1. Enter the appropriate injury and sequelae codes for the problems responsible for the treatment being invoiced.
  2. To search for a code, click the “…” button. (View screenshot)
  3. List each code only once, regardless of how many Health Professionals will be engaged in treatment.
  4. The first line item should reflect the primary reason or problem that is most responsible for the proposed services.
    • Example:If psychological services are required after a brain injury, the first code listed should reflect the reason that psychology services are being proposed. F07.2 – Postconcussional Syndrome, and then S06 – Concussion.
    • In a case where multiple injuries may be classified as the most significant, list the injury requiring the most services first.

Invoicing for assessment services

  1. If  invoicing for  assessment  services,  enter  the  injury/problem  code(s)  most appropriate for  the claimant based on the assessment findings.
  2. Ifinvoicing prior to the; assessment’s  completion  and  no  impairment  has  yet  been identified, code the problem that instigated the assessment.
    • Example: An  OCF-18 assessment  proposal  was  generated  due  to  an  ongoing  pain  in  the absence of abnormal physical findings.

Questions about coding
If you have questions about which injury code(s) to use, contact your health professional association. HCAI Support do not have medical training and cannot help you select a code.

Common codes

  • Single physical injury – refer to S codes. (e.g. S42.0 – Fracture of clavicle)
  • Multiple injuries and bilateral injuries – refer to T codes (do not list duplicate codes for bilateral injuries).
  • Mental and behavioral disorders – refer to F codes.
  • Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified – refer to R codes.

Adding additional lines for injury/sequelae codes

If more space is required for additional injuries or problem codes, extra lines may be added by clicking the “+” button. (View screenshot)

Reimbursable Goods and Services


This section uses CCI (Canadian Classification of Interventions) codes or GAP (Goods, Administration, and Other) codes, as well as Unit Measures and Provider Type codes. You can find partial and complete code lists here:

If more space is required for additional goods and services, extra lines may be added.

  • Select the number of lines you wish to add using the “Add more items” dropdown list just above the “Calculate cost from rates” button, then click “Go”.

You can also visit the Coding page or watch the Treatment Coding Basics video for more information.

View screenshot of section.

Date service rendered

  1. All dates that the Patient attended for treatment should be listed. Dates should be formatted YYYY/MM/DD, or the calendar function may be used.

Code

  1. Enter the intervention code by typing it directly into the field, or use the code search utility by clicking the “...” button next to the “Code” field.
  2. The “Search Goods and Services Codes” window opens. Select either “CCI” or “GAP”. (View screenshot)

    • CCI are international standard codes for health interventions.
    • GAP codes were developed by Insurance Bureau of Canada with the help auto insurers and health care providers, and can be used for services that are not well reflected in the CCI, such as:
      • Administrative services such as travel time and mileage
      • Pre-claim examination
      • Goods and Supplies
      • Health Provider Initiated Examination & Insurer Initiated Examination, including  Attendant care, Catastrophic, Disability (Pre 104 weeks and Post 104 weeks), Combined (MedRehab and Disability), and MedRehab
      • Telephone consultation with other Health Providers
  3. Once you have selected CCI or GAP, the Section drop-down menu will populate.
  4. Pick a Section in order to have the Intervention drop-down menu populate.
  5. Pick an Intervention in order to have the Group drop-down menu populate.
  6. Select a Group and hit the “Search” button.
  7. The search results appear. To add a code to your plan, click the “Add” button.

Attribute

  1. In addition to the CCI codes, health care services can be further specified with “Attribute Codes”. These codes are used to indicate how the service was delivered, such as the number of views in an X-ray study.
    • The absence of attribute codes means that the service was rendered directly (in person) to one individual by one individual Provider and required continuous attendance.
    • Refer to page 2 of Appendix B for more information about Attributes.

Provider Reference

  1. To select the Provider who delivered care, click on the “...” button to open the Select a Provider window. (View screenshot)
  2. Use the drop-down menu to select the Provider. If more than one Provider delivered care, list only the one who was most responsible for each visit and who will be most likely to be listed on the invoice.
  3. If the Provider has a default hourly rate assigned, that figure will also appear.
  4. Use the Profession drop-down menu to select the applicable profession if the Provider has more than one assigned in HCAI.

To insert the same Provider for multiple line items (View screenshot)

  1. Complete all fields except for “Provider Reference”.
  2. Check the box to the left of each completed line item that you wish to assign the same Provider(s) to.
  3. Click the “Apply Providers” button and select the name of the Provider(s) from the dropdown list.

Quantity/Unit measure

  1. Enter the quantity and unit measure of service that will be provided during a single treatment visit/session. For example:
    • 15 minutes = 0.25 HR
    • 1 procedure = 1 PR
    • 1 good (such as a back support) = 1 GD
    • 10 km = 10 KM
    • 1 session = 1 SN
    • Click here to view more about Unit Measures (PDF)

Cost

  1. HCAI allows Facilities to enter a default hourly rate for each Provider under the Facility Management screen. This can be used to calculate the cost per line of treatment. If the Measure assigned is HR and the Provider has an assigned hourly rate, the cost will be calculated automatically based on the Provider’s default hourly rate. Click here to learn how to assign an hourly rate to a Provider.
  2. You may click on the “Calculate costs from rates” button to override the value in the Cost field for any measure of HR or KM and assign the default rates.
  3. If the Provider selected does not have a default hourly rate assigned, or you need to use a different rate, enter the value in the Cost field.
  4. Be sure to report the cost per service as the service is described in the line.
    • For example: 15 minutes of massage or 0.25 HR by a Massage Therapist = 25% of the RMT’s hourly fee.

Facilities may charge fees in excess of the Superintendent’s Professional Fee Guideline, but Insurers are not required to pay fees that exceed that Guideline.

Add more items
To add lines for additional goods and/or services, select the number of lines you wish to add using the “Add more items” dropdown list just above the “Calculate Costs From Rates” button, then click the “GO” button.

Prior Balance, Overdue Amounts and Interest Charges
If the Facility has submitted an invoice prior to the current invoice, but it has not been fully paid, you may document the outstanding amount and associated interest on this invoice. (View screenshot)

  1. Insert the Prior Balance – which is the amount of the previous invoice.
  2. Insert thePayment Received from Auto Insurer.
  3. Insert the Overdue Amount* from the previous invoice.
  4. Insert the Interest as calculated on the overdue amount.

* The overdue amount, prior balance, and payment received from auto Insurer will not be added to the Auto Insurer Total on this new invoice. Only the interest amount will be added to this invoice. The previous invoice is still effective and amounts from prior invoices should not be added to new invoices.

Other Insurance


  1. Select “Yes” or “No” to establish whether there is other insurance coverage. (View screenshot)
    • If “Yes” is selected, enter the information underneath Other Insurer 1 and, if applicable, Other Insurer 2. These fields are not mandatory and can be left blank if you do not have the information.

Other Insurance (for goods and services on this invoice) (View screenshot)

  1. If amounts are payable by another insurer, enter the amounts in the category of service. Do not use a negative (-) sign for these amounts. These amounts will be deducted from the amount owed by the Insurer.
  2. When the category “Other” is used, specify the type of services covered (e.g. dental, psychological, optometric).
  3. To enter amounts previously identified for payment by another Insurer but subsequently ruled ineligible, select “Yes” for the question, “Do you want to claim any amounts not reimbursed by other insurance sources?”
    • Enter the amounts for the corresponding Insurer in the section that appears.
  4. Click the “Calculate” button to see the total for each line.

Totalling

This section sums up the costs outlined on this invoice. It is possible to invoice for amounts greater than or less than those proposed on a plan, but the Insurer may request an explanation.

Sub-total: Sum of the cost of all amounts entered in Reimbursable Goods and Services section.

Minus MOH: Sum of all Ministry of Health and Long-Term Care amounts (this amount is taken from the “Charged Services” MOH line). Amounts paid to you or expected to be paid to you are subtracted from the amount billed to the Auto Insurer. Amounts that you previously stated were available to you but were unable to collect will be added to the Auto Insurer’s invoice.

Minus Other Insurer (1 + 2): Sum of all amounts received or payable to you from other Insurers. This amount is taken from the “Charged Services” of Other Insurer 1 and 2. Amounts paid to you or expected to be paid to you are subtracted from the amount billed to the Auto Insurer. Amounts that you previously stated were available to you were unable to collect will be added to the Auto Insurer’s invoice.

Tax: Sum of taxable amount for any goods or services subject to the Harmonized Goods and Services Tax (13%) or other applicable tax. 

Prior Balance*: Enter Prior Balance (the Auto Insurer Total from your last invoice).

Payment Received from Auto Insurer: Any additional payments received. 

Overdue Amount*: Subtract payments received since your last invoice to calculate the overdue amount.

Interest*: Enter the interest owing as a result of the overdue amount.

Auto Insurer Total: Sum of all amounts in this section.

*Prior Balance, Overdue Amount and Interest are used as the basis for interest charges that have accumulated and can be calculated into the Auto Insurer Total for this invoice. Only the interest charges will be calculated into the total payable by the Auto Insurer.

Calculating Prior Balance, Overdue Amounts and Interest Charges
If the Facility has submitted an invoice prior to the current invoice, but it has not been fully paid, you may document the outstanding amount and associated interest on this invoice. (View screenshot)

  1. Insert the Prior Balance – which is the amount of the previous invoice.
  2. Insert the Payment Received from Auto Insurer from the previous invoice.
  3. Insert the Overdue Amount* from the previous invoice.
  4. Insert the Interest as calculated on the overdue amount.

*The overdue amount will not be added to the Auto Insurer Total on this new invoice. Only the interest amount will be added to this invoice. The previous invoice is still effective and amounts from prior invoices should not be added to new invoices.

Additional Information


Space is available for comments if there is a need to provide the Insurer additional explanations/clarifications. There is a limit of 500 characters in the comments field. If more space is needed, use Tab 5. (View screenshot)

Additional Comments


The Additional Comments section allows the facility to offer additional information about the Applicant, their injuries, care, treatment, response to treatment, or anything else that will help the Insurer understand the Applicant story. (View screenshot)

  1. You can cut and paste plain text—from a Word document, for example—but you cannot copy and paste complex tables, charts, or images.
    • There is a limit of 20,000 characters.
  2. If you are sending attachments to the Insurer, check off the box next to “Attachments being sent, if any”. Then use the space to describe the attachment. This tells the adjuster not to adjudicate the form until they have received the documents you are sending.
    • If you’d like to submit an attachment as part of the OCF, you cannot embed it into the OCF. Items like PDF files, Excel files, or Word documents must be faxed or mailed directly to the Insurer.
  1. If you’d like to save the OCF as a Draft,  you can click “Save”. A yellow bar across the top will indicate that your form has been saved successfully. (View screenshot)
  2. If you are ready to submit your OCF, click “Submit”. The successful submission window will appear. A unique HCAI document number is generated. This number can be used to track this form.   Insurance adjusters can also track this form in their system using this document number. (View screenshot)
  3. To print the submitted OCF, click the “Print” button. The HCAI document number will be displayed on the printed form.

Process Overpayments or Credit

Occasionally, a Facility may wish to reimburse an Insurer for overpayment or to issue a credit. You may create a single invoice for the overpayment/credit, or process the overpayment/credit with other goods and services on an invoice.

  1. If you are creating a single invoice only for the overpayment/credit, create the OCF-21B either from a plan or from scratch. When you reach the Reimbursable Goods and Services section, enter one line item. The amount entered under “Cost” for the line item should be 0.00. (View screenshot)
  2. If you are processing the overpayment/credit with other goods and services, skip the step above and begin at Step 3, below.
  3. Go to the Other Insurance section, in Tab 4 of the OCF-21B.
  4. Select the button labeled “Yes – There is other insurance coverage…..”
  5. In the ‘Other Insurer 1’ section, enter the name of the auto insurer in the Other Insurer Name box. (View screenshot)
  6. Go to Part 9: “Other Insurance (for goods and services on this invoice)” and enter the amount for repayment in the Insurer 1 row, in the column labeled **Other Service.
  7. In the box labeled “**Other Service Type Specified”, write in the reason for the credit. You may, for example, choose to write “Overpayment by insurer” or “Overpayment/Credit of [xxx]” in this box.
  8. Go to the Totalling section.
  9. Click the “Calculate” button. The credit amount will be displayed in the “Proposed” column within the “Minus Other Insurer (1+2)” field.
  10. Submit the form.

Collect Interest Owed on Outstanding Invoices

The SABS S.51 authorizes payment of interest on overdue amounts, for plans that have been approved by insurers and invoiced more than 30 days ago. This can be done via HCAI.
To charge interest on outstanding amounts owed to your Facility using, the process depends on whether the patient is still receiving services at your clinic or not.

If the claimant is still attending treatment
When preparing the next invoice for a patient still attending treatment, we recommend adding the interest owing to the next invoice, in the Totalling section.

The Totalling section allows you to outline the Prior Balance, the Payment Received by Auto Insurer, the Overdue Amount, and the Interest. When you press the “Calculate” button, only the interest charge will be added to the total amount proposed to be payable by the Insurer on this new invoice. (View screenshot) for an example.

If the claimant is discharged
If you have discharged the claimant and no further invoices are to be submitted, you can prepare a new invoice only for the interest amount as follows: (View screenshot)

  • Create an invoice from the plan on which interest is owing. This way, the interest invoice will be linked to the plan for which payment is outstanding.
  • Enter only one item in Tab 3 under Reimbursable Goods and Services. This is because HCAI requires at least one line item. The cost of the line item should be 0.00.
  • In the Totalling section, enter the information about the outstanding amount and add the interest charges.
  • Go to the Additional Comments section on Tab 5, and enter a note explaining that this invoice is to charge interest on the outstanding balance for this treatment plan.
  • Press the “Save” button to save a draft of this invoice for future use, if you wish.
  • Submit the form.

The Insurer will now have two distinct invoices for the outstanding plan: the one that was submitted originally, and the one charging interest.

Please note: To collect on outstanding invoiced amounts (rather than interest), you may not submit duplicate invoices. This should instead be done by means of a “statement”. The statement is not an OCF and should be sent by fax or mail, not submitted through HCAI.

Download PDF Manual

OCF-21B HCAI User Manual (PDF)

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