Health Care Facility | Insurers | Related Initiatives  

Track My OCF


There are three sub-tabs under the Plans and Invoices tabs where your saved or submitted forms may reside.

Work in Progress tab contains OCFs that have been submitted but not yet adjudicated. Here you can review and track the status of your submitted OCFs.

Adjuster Response tab contains OCFs that have been adjudicated by an Adjuster. You can now review the OCF to find more information about the adjuster’s response.

Drafts tab contains incomplete OCFs that have been saved. You can save unfinished forms to the Drafts tab to continue at a later date, or to use as a template to make submission quicker and easier in the future. Submitting an OCF from the Draft tab does not remove the Draft from the tab; the draft version remains until it is manually deleted. It is best practice to delete draft OCFs that are older than one year. Older drafts may reflect outdated versions of the OCF and may not be able to be submitted.

Use the side menu to learn more about tracking the status of your submitted OCFs, reviewing adjuster responses and understanding the status of your adjudicated form, and creating/deleting drafts.

Track My OCF


Work in Progress

The Work in Progress tab contains OCFs that have been submitted but not yet adjudicated. Here you can review and track the status of your submitted OCFs.

  • How do I know if my OCF has been submitted?
    How do I know if my OCF has been submitted?

    HCAI provides a confirmation message once an OCF has been successfully submitted. The message states “You have submitted document number…” This unique number can be used to track your OCF. (View screenshot)

  • What does ‘status’ mean?
    How do I know if my OCF has been submitted?

    On the Work in Progress sub-tab, each OCF is assigned a status. The following list describes what is meant by each status that the HCAI system assigns to an OCF:

    • Submitted – The plan has been submitted but not yet reviewed.
    • Review Required The Insurer has opened the plan.
    • In Discussion – The Adjuster has posed a question for the Facility that submitted the form.
    • In Discussion; Response Sent – the Facility has replied to the Adjuster’s question
  • What if my OCF has not yet been adjudicated?
    How do I know if my OCF has been submitted?

    OCFs submitted via HCAI are subject to the Statutory Accident Benefits Schedule (SABS). HCAI is not responsible for enforcing the SABS timelines.

    If you have submitted an OCF and it has not been adjudicated within the SABS published timeline, contact your Patient’s Adjuster/Insurer.

  • How do I search for a submitted OCF?
    How do I know if my OCF has been submitted?

    Use the Search tab find an OCF that meets specific criteria. The search is done on submitted OCFs only—draft OCFs are excluded. (View screenshot)

    You can search by date submitted, document number, claim number, policy number, date of accident, date of birth, claimant name, claimant phone number, or a combination of these criteria.

    When the “Exact Match” box is checked off, the search results will be identical to the criteria entered.

    Click “Advanced Options” at the bottom of the Search screen to search by document type, adjudication status, or archival status.

  • How do I search for an archived OCF?
    How do I know if my OCF has been submitted?

    1. Use the Search tab to search for an archived OCF.  The search is done on submitted OCFs only (draft OCFs are excluded).
    2. Click “Advanced Options” at the bottom of the Search screen.
    3. Beside Archived Status, select the “Archived” button to search for an archived OCF. You may fill in any other search criteria to narrow your search. (View screenshot)

Track My OCF


Adjuster Response

When an adjuster has adjudicated your OCF, you can find it under the Adjuster Response tab. You can now review the OCF to find more details about the Adjuster’s response.

  • How Do I Review My Submission?
    1. From the Adjuster Response tab, click on the Review Form button next to the OCF you want to open. (View screenshot)
    2. The Summary page is automatically generated after the OCF is submitted. It provides an overview of the OCF and also displays the OCF’s message log and current state.
    3. In the Part 3: Plan/Invoice Details section you will see:
      • Document Number: This is a system-generated number unique to the plan.
      • Owner: This field displays the name of any Adjuster who is currently working on the plan.
      • Status:
        • Approved – The Adjuster has approved all the goods and services proposed under the plan.
        • Partially Approved – The Adjuster has approved only some of the goods and services proposed under the plan.
        • Declined – The Adjuster has not approved any of the goods or services proposed under the plan.
        • Responded – This status is only available on the OCF-23 and indicates that the Applicant (Patient) has a valid policy of insurance in force. The OCF-23 is a claim for “pre-approved” services, so the Adjuster cannot “Approve” an OCF-23.

    Reviewing the Adjudicated Form

    Each Tab of an adjudicated OCF contains read-only details presented in the same order as they were entered. Navigate through the plan by using the numbered tabs.

    The following sections contain changes or response details from the Insurer:

    Part 1: Applicant Information. The Applicant (Patient) details provided in the initial plan are linked to the Insurer claimant details. You can see both in this section.

    Part 2: Auto Insurer Information.The Applicant (Patient) details provided in the initial plan are displayed.

    Part 12: Proposed Goods and Services. The table has a new column – Adjuster Response – containing the Adjuster’s decision per service. If a service is declined, the reason code will display below.

    Totalling: This section contains Proposed Amount Submitted next to the Approved Amount as recorded by the Adjuster.

    Signature of Insurer: At the bottom of Tab, it contains Adjuster’s first and last name.

  • What does ‘status’ mean?

    Once an OCF is adjudicated in HCAI, it is assigned a status:

    Approved – the Insurer has approved all aspects of the submitted or amended document.

    Partially Approved – the Insurer has approved some of the items requested on the plan or invoice. When the Facility opens the adjudicated plan/invoice, the Facility will be able to view the Adjuster’s reason code and additional details in the ‘Explanation of adjuster response’ box explaining why the decision was made, if the Adjuster has provided details.

    Declined – the Insurer has declined the items requested on the plan or invoice. In these cases, the Insurer may notify the Applicant (Patient) of the decision via an OCF-9 and also will notify Applicant (Patient) of the next steps. When the Facility opens the adjudicated plan/invoice, the Facility will be able to see the reason for the Adjuster’s decision.

    Responded – this response is specific to the OCF-23 and indicates that the Applicant (Patient) has a valid policy of insurance in force.   This is because The OCF-23 is a claim for “pre-approved” services. For this reason, the Adjuster cannot “Approve” an OCF-23. However, any goods and services delivered to Applicant (Patient) within the MIG framework are still subject to adjudication.

  • What if my OCF has been declined?

    Once a plan or invoice has been adjudicated, Facilities may open the plan or invoice to determine why the plan was declined or partially approved.

    1. Go to the Plans or Invoices global tab (depending on whether you are looking for an adjudicated plan or invoice).
    2. Go to the Adjuster Response tab.
    3. Locate the plan/invoice you want to open.
    4. Click on the Review Form button () at the left of the window to open the plan or invoice.

    When you review the “Proposed Goods and Services” section, you will see which services were approved and which were not. (View screenshot)

    For all services not approved, the Adjuster must provide an Adjuster Response code and explanation. These are summarized in the following Adjudication Reason Codes (PDF).

    If you require more information about why a good or service was declined, contact the Adjuster or speak with the Applicant/Patient who will have received an explanation of benefits notice from the Insurer.

  • What is the Explanation of Benefits (EOB) form?
    What is the EOB?

    The Explanation of Benefits form (EOB), formerly known as the OCF- 9 is a statement sent to the claimant from their insurer explaining what medical treatments and/or services will be paid (or not) for on their behalf.

    The EOB can be generated by HCAI once an adjuster has recorded a decision against a submitted OCF document.

    The adjuster provides a printed copy of the EOB to the claimant. They can also choose to submit the EOB via HCAI, which will make it available to be viewed by the facility that submitted the OCF.

    If an EOB has been sent, an icon will appear on the Adjuster Response tab in HCAI, next to the OCF type column. (View screenshot)

    To view the EOB:

    1. Click on the Review Form  button to open the OCF.
    2. Click on the “View EOB” button on the OCF summary tab. The EOB opens in a new window.
    3. To view the adjudication decision, click on tab 2 of the EOB.
    4. The “Medical and Rehabilitation and Other Benefits” included in Part 4 of the OCF are listed.
    5. The “Reason why expenses are not payable or being stopped” section includes the adjudication reason codes and the corresponding explanation for each code.

    Please note: The Safety, Licensing Appeals and Standards Tribunal Ontario (SLASTO) has assumed all new applications for dispute resolution from the Financial Services Commission of Ontario. To streamline the user viewing experience on HCAI, Tab 3, which used to contain the Applicant’s Rights to Dispute, will be hidden from the web view. The new wording will be displayed on the paper or PDF versions of the EOB only.

Track My OCF


Draft

The Drafts tab contains incomplete OCFs that have been saved. You can save unfinished forms to the Drafts tab to continue at a later date, or to use as a template to make submission quicker and easier in the future. Submitting an OCF from the Draft tab does not remove the Draft from the tab; the draft version remains until it is manually deleted.

It is best practice to delete draft OCFs that are older than one year. Older drafts may not reflect the most recent OCF version in HCAI and may not be able to be submitted.

  • How do I create or delete a draft?
    What does it mean if an OCF is in the Draft tab?

    To create a Draft OCF:

    When an OCF is created, it can be saved as a draft by clicking the “Save” button. A yellow bar will appear to indicate you have successfully saved the draft. You are then free to exit the OCF. (View screenshot)

    In order to save an OCF as a draft, the following fields must be completed (but can be modified in the future):

    • Claim or Policy Number
    • Patient First Name
    • Patient Last Name

    You can then access your draft by clicking the Draft sub-tab from the Plans or Invoices tab.

    To delete a Draft OCF:

    • Click on the Draft sub-tab within the Plans tab.
    • You can click on “Date Modified” to sort drafts from oldest to newest if desired. Date Modified is the date the document was last modified. Every time an OCF in the Draft tab is changed or updated and these modifications are saved, HCAI records the date the modifications occurred.
    • Use the checkboxes on the left side to select the drafts you wish to delete. You may select more than one draft to delete.
    • Click on the Delete button.
    • Click “Okay” on the pop-up prompt that appears.
  • Why can’t I find my draft OCF?
    Why can’t I find my draft OCF?

    OCFs that have been saved automatically go to the Draft folder.

    If you saved an OCF and cannot find it, make sure you are looking in the correct global tab – Plans or Invoices.

Track My OCF


There are three sub-tabs under the Plans and Invoices tabs where your saved or submitted forms may reside.

Work in Progress tab contains OCFs that have been submitted but not yet adjudicated. Here you can review and track the status of your submitted OCFs.

Adjuster Response tab contains OCFs that have been adjudicated by an Adjuster. You can now review the OCF to find more information about the adjuster’s response.

Drafts tab contains incomplete OCFs that have been saved. You can save unfinished forms to the Drafts tab to continue at a later date, or to use as a template to make submission quicker and easier in the future. Submitting an OCF from the Draft tab does not remove the Draft from the tab; the draft version remains until it is manually deleted. It is best practice to delete draft OCFs that are older than one year. Older drafts may reflect outdated versions of the OCF and may not be able to be submitted.

Download PDF Manual

Tracking Plans and Invoices User Manual (PDF)

  • Work in Progress

    How do I know if my OCF has been submitted?

    The Work in Progress tab contains OCFs that have been submitted but not yet adjudicated. Here you can review and track the status of your submitted OCFs.


    HCAI provides a confirmation message once an OCF has been successfully submitted. The message states “You have submitted document number…” This unique number can be used to track your OCF. (View screenshot)

    What does ‘status’ mean?


    On the Work in Progress sub-tab, each OCF is assigned a status. The following list describes what is meant by each status that the HCAI system assigns to an OCF:

    • Submitted – The plan has been submitted but not yet reviewed.
    • Review Required The Insurer has opened the plan.
    • In Discussion – The Adjuster has posed a question for the Facility that submitted the form.
    • In Discussion; Response Sent – the Facility has replied to the Adjuster’s question

    What if my OCF has not yet been adjudicated?


    OCFs submitted via HCAI are subject to the Statutory Accident Benefits Schedule (SABS). HCAI is not responsible for enforcing the SABS timelines.

    If you have submitted an OCF and it has not been adjudicated within the SABS published timeline, contact your Patient’s Adjuster/Insurer.

    How do I search for a submitted OCF?


    Use the Search tab find an OCF that meets specific criteria. The search is done on submitted OCFs only—draft OCFs are excluded. (View screenshot)

    You can search by date submitted, document number, claim number, policy number, date of accident, date of birth, claimant name, claimant phone number, or a combination of these criteria.

    When the “Exact Match” box is checked off, the search results will be identical to the criteria entered.

    Click “Advanced Options” at the bottom of the Search screen to search by document type, adjudication status, or archival status.

    How do I search for an archived OCF?


    1. Use the Search tab to search for an archived OCF.  The search is done on submitted OCFs only (draft OCFs are excluded).
    2. Click “Advanced Options” at the bottom of the Search screen.
    3. Beside Archived Status, select the “Archived” button to search for an archived OCF. You may fill in any other search criteria to narrow your search. (View screenshot)
  • Adjuster Response

    How Do I Review My Submission?

    When an adjuster has adjudicated your OCF, you can find it under the Adjuster Response tab. You can now review the OCF to find more details about the Adjuster’s response.

    1. From the Adjuster Response tab, click on the Review Form button next to the OCF you want to open. (View screenshot)
    2. The Summary page is automatically generated after the OCF is submitted. It provides an overview of the OCF and also displays the OCF’s message log and current state.
    3. In the Part 3: Plan/Invoice Details section you will see:
      • Document Number: This is a system-generated number unique to the plan.
      • Owner: This field displays the name of any Adjuster who is currently working on the plan.
      • Status:
        • Approved – The Adjuster has approved all the goods and services proposed under the plan.
        • Partially Approved – The Adjuster has approved only some of the goods and services proposed under the plan.
        • Declined – The Adjuster has not approved any of the goods or services proposed under the plan.
        • Responded – This status is only available on the OCF-23 and indicates that the Applicant (Patient) has a valid policy of insurance in force. The OCF-23 is a claim for “pre-approved” services, so the Adjuster cannot “Approve” an OCF-23.

    Reviewing the Adjudicated Form

    Each Tab of an adjudicated OCF contains read-only details presented in the same order as they were entered. Navigate through the plan by using the numbered tabs.

    The following sections contain changes or response details from the Insurer:

    Part 1: Applicant Information. The Applicant (Patient) details provided in the initial plan are linked to the Insurer claimant details. You can see both in this section.

    Part 2: Auto Insurer Information.The Applicant (Patient) details provided in the initial plan are displayed.

    Part 12: Proposed Goods and Services. The table has a new column – Adjuster Response – containing the Adjuster’s decision per service. If a service is declined, the reason code will display below.

    Totalling: This section contains Proposed Amount Submitted next to the Approved Amount as recorded by the Adjuster.

    Signature of Insurer: At the bottom of Tab, it contains Adjuster’s first and last name.

    What does ‘status’ mean?

    Once an OCF is adjudicated in HCAI, it is assigned a status:

    Approved – the Insurer has approved all aspects of the submitted or amended document.

    Partially Approved – the Insurer has approved some of the items requested on the plan or invoice. When the Facility opens the adjudicated plan/invoice, the Facility will be able to view the Adjuster’s reason code and additional details in the ‘Explanation of adjuster response’ box explaining why the decision was made, if the Adjuster has provided details.

    Declined – the Insurer has declined the items requested on the plan or invoice. In these cases, the Insurer may notify the Applicant (Patient) of the decision via an OCF-9 and also will notify Applicant (Patient) of the next steps. When the Facility opens the adjudicated plan/invoice, the Facility will be able to see the reason for the Adjuster’s decision.

    Responded – this response is specific to the OCF-23 and indicates that the Applicant (Patient) has a valid policy of insurance in force.   This is because The OCF-23 is a claim for “pre-approved” services. For this reason, the Adjuster cannot “Approve” an OCF-23. However, any goods and services delivered to Applicant (Patient) within the MIG framework are still subject to adjudication.

    What if my OCF has been declined?

    Once a plan or invoice has been adjudicated, Facilities may open the plan or invoice to determine why the plan was declined or partially approved.

    1. Go to the Plans or Invoices global tab (depending on whether you are looking for an adjudicated plan or invoice).
    2. Go to the Adjuster Response tab.
    3. Locate the plan/invoice you want to open.
    4. Click on the Review Form button () at the left of the window to open the plan or invoice.

    When you review the “Proposed Goods and Services” section, you will see which services were approved and which were not. (View screenshot)

    For all services not approved, the Adjuster must provide an Adjuster Response code and explanation. These are summarized in the following Adjudication Reason Codes (PDF).

    If you require more information about why a good or service was declined, contact the Adjuster or speak with the Applicant/Patient who will have received an explanation of benefits notice from the Insurer.

    What is the Explanation of Benefits (EOB) form?


    The Explanation of Benefits form (EOB), formerly known as the OCF- 9 is a statement sent to the claimant from their insurer explaining what medical treatments and/or services will be paid (or not) for on their behalf.

    The EOB can be generated by HCAI once an adjuster has recorded a decision against a submitted OCF document.

    The adjuster provides a printed copy of the EOB to the claimant. They can also choose to submit the EOB via HCAI, which will make it available to be viewed by the facility that submitted the OCF.

    If an EOB has been sent, an icon will appear on the Adjuster Response tab in HCAI, next to the OCF type column. (View screenshot)

    To view the EOB:

    1. Click on the Review Form  button to open the OCF.
    2. Click on the “View EOB” button on the OCF summary tab. The EOB opens in a new window.
    3. To view the adjudication decision, click on tab 2 of the EOB.
    4. The “Medical and Rehabilitation and Other Benefits” included in Part 4 of the OCF are listed.
    5. The “Reason why expenses are not payable or being stopped” section includes the adjudication reason codes and the corresponding explanation for each code.

    Please note: The Safety, Licensing Appeals and Standards Tribunal Ontario (SLASTO) has assumed all new applications for dispute resolution from the Financial Services Commission of Ontario. To streamline the user viewing experience on HCAI, Tab 3, which used to contain the Applicant’s Rights to Dispute, will be hidden from the web view. The new wording will be displayed on the paper or PDF versions of the EOB only.

  • Draft

    How do I create or delete a draft?

    The Drafts tab contains incomplete OCFs that have been saved. You can save unfinished forms to the Drafts tab to continue at a later date, or to use as a template to make submission quicker and easier in the future. Submitting an OCF from the Draft tab does not remove the Draft from the tab; the draft version remains until it is manually deleted.

    It is best practice to delete draft OCFs that are older than one year. Older drafts may not reflect the most recent OCF version in HCAI and may not be able to be submitted.


    To create a Draft OCF:

    When an OCF is created, it can be saved as a draft by clicking the “Save” button. A yellow bar will appear to indicate you have successfully saved the draft. You are then free to exit the OCF. (View screenshot)

    In order to save an OCF as a draft, the following fields must be completed (but can be modified in the future):

    • Claim or Policy Number
    • Patient First Name
    • Patient Last Name

    You can then access your draft by clicking the Draft sub-tab from the Plans or Invoices tab.

    To delete a Draft OCF:

    • Click on the Draft sub-tab within the Plans tab.
    • You can click on “Date Modified” to sort drafts from oldest to newest if desired. Date Modified is the date the document was last modified. Every time an OCF in the Draft tab is changed or updated and these modifications are saved, HCAI records the date the modifications occurred.
    • Use the checkboxes on the left side to select the drafts you wish to delete. You may select more than one draft to delete.
    • Click on the Delete button.
    • Click “Okay” on the pop-up prompt that appears.

    Why can’t I find my draft OCF?


    OCFs that have been saved automatically go to the Draft folder.

    If you saved an OCF and cannot find it, make sure you are looking in the correct global tab – Plans or Invoices.