1. When is HCAI Responsible for the privacy and security of PII (Personally Identifiable Information) and of PHI (Personal Health Information)?

HCAI becomes responsible for data:

1. When the data enters the HCAI system;
2. While the data is stored by HCAI; and
3. When HCAI destroys the data

2. When are insurer, Health Care Facilities (HCFs) and health care providers responsible for HCAI data?

Any data that has been printed is your responsibility. You are also responsible to understand and manage user profiles to ensure only authorized personnel are able to view patient data for data as it is being entered by your staff. Your staff must be trained on how to prevent non-authorized persons from viewing or accessing data that is on the screen or in the draft folder.

3. What is the most common security issue with users?

Password design and security is by far the weakest link in maintaining confidentiality. Users tend to design passwords that are easily remembered because they are names, dates or words. These are easily guessed by family and friends or hacked. Due to forced password changes users write new passwords down and leave them near the computer. Following in question #6 below are suggestions on designing a password that is secure and easily changed when required to do so.

4. Is printed data protected by HCAI?

No, once an OCF is printed it is your responsibility to protect it. Your organization’s policies on data protection should cover your responsibilities. Although HCAI is responsible while data is in the HCAI system, it is your responsibility to your client/claimant/patient to protect their PII at all times. This is why HCAI has made commitments to privacy which your organization has reviewed and, in turn, made commitments of their own.

5. If we are using the Data Entry Centre (DEC) and a fax is sent to the wrong place what do we do?

Faxing protocols should include the use of pre programmed numbers so that errors do not occur.

• Staff should double check that they have chosen the right number from the pre-programmed list;
• or, entered the correct number if there is no list.
• All faxes should have a cover page indicating contact information should the fax go to the wrong number.
• Should you discover a fax has been sent to the wrong number contact your Privacy Officer (PO) immediately and follow their directions. Not informing the PO leads to a serious breach of privacy regulations.

6. How can I design a password that is secure, but easy to manage?

Some common features of secure passwords are:

• Minimum of 6 characters
• Do not use words, names or dates (hackers love these)
• Use as many as possible of large and small cap letters, numbers and special characters (&^#<)
• You only need to design one good password and you can use it everywhere and forever! (Maybe a second one if there is lots of money in that account)Examples (you can’t use these, get creative)
• J&Jwuth2 (Jack and Jill went up the hill to)
• 2L8aga1n (too late again)
• Use a line from a favourite song, a saying someone uses, a line of poetry etc. Use zero for o, number one for L or I, 8 for the eh sound, & for and, insert commas to separate letter strings or numbers

Reusing Secure Passwords

Examples:

• J&Jwuth2 becomes J&Jxuth2 or J&Jvuth2
• 2L8aga1n = 2L8aga2n

TIP:
If you need to write it down, write only the letter or number you have changed.

7. I work share with another staff member, can we share passwords?

This is not a best practice. HCAI permits each user to have a distinct username and password and still be able to share work with another person. However; we understand this is an issue with managing the work flow. Be aware that HCAI can track only whose password has been used; we cannot determine which person entered it. Come to an understanding with your partner about the necessity of not sharing passwords with others and accessing only what is necessary to your role. If you feel your partner is not following the rules speak to your manager. If you have knowledge abut a possible privacy breach and do not report it, the law considers you just as responsible as the person committing the breach.

8. Are there special precautions when accessing via laptop or from a home computer?

Consider who can see your screen: family members, other passengers or anyone around you. With wireless access so readily available, users are working on their way to or from work, while waiting for appointments etc. Others who are bored or curious feel little guilt about reading what is available.

• Do not write your passwords or leave Virtual Private Network (VPN) tokens in your laptop bag or at your home computer.
• Where possible, avoid copying sensitive data to the hard drive of a portable unit or to a PSD (portable storage device).
• HCFs maintaining copies of PDF OCFs are responsible for maintaining a secure system with audit trails.
• Clear your cache after using one of these devices, mandatory if you have signed on from a publicly available computer like in an internet cafe or library.

9. How can I avoid getting suspended from my account?

For security reasons, if a password is entered incorrectly on three consecutive tries, the user account will be suspended. At that point, you must request your clinic’s Authorizing Officer or a User Administrator to reset your password.

Here are some tips to prevent this:

• If you copy and paste a password, be sure you have not included spaces in the copied text. The space will invalidate your password.
• Passwords are case sensitive. Take care to type it in correctly.
• If you have incorrectly entered your password (or username) twice, do not try a third time. Instead, click on the link to reset your password (see figure 1)).  A new temporary password will be sent to you by email.

10. I am suspended from my account. How do I get a password reset?

Ask the Authorizing Officer or User Administrator at your clinic/practice to reset your password.

11. I don’t know who the Authorizing Officer (AO) or User Administrator (UA) is. How can I find out?

Each clinic/practice has an Authorizing Officer (AO). In addition, the AO may have assigned other User Administrators (UA). If you are not sure who is the AO or UA is, ask the owner or senior manager of the practice.

12. I am a User Administrator (or Authorizing Officer) and my account is suspended. How do I get a password reset?

When your practice was first activated, the AO was advised to set up a back-up UA. That means that there should always be at least two people in the organization who have the capability to reset passwords. If the AO or UA is suspended, they should go to the other person (another UA or the AO) and request that a password reset be done.

13. I am the AO but I did not set up a back-up UA. How do I get a password reset if I’m suspended?

You must contact Helpdesk at facilityenrolment@hcaiinfo.ca and request a password reset.

Important: only the AO or someone with the UA role can request a password reset from Helpdesk.

14. When a clinic associates me as a provider, they ask me to sign a Provider Terms and Conditions form. Does my signature on this form give them the right to use my signature on OCF 18s, 22s or 23s?

NO! Your signature on the Provider Terms and Conditions form only verifies that you have agreed to abide by the HCAI Electronic Access Terms and Conditions. It has no relationship to your signature (as a health practitioner or health professional) on OCF forms. Each OCF form must be individually printed and signed by the health practitioner/professional and claimant.

15. Do I have to sign each and every OCF form in which I am identified as the signing health practitioner or health professional?

Yes. After you have signed a form, by putting pen to a printed copy of the form, the signed form must be kept on file by the clinic. Typically this is retained as part of the patient file.

16. My practice is enrolled to use the HCAI web application. What kinds of policies and procedures should I set up to ensure compliance with PIPEDA and PHIPA?

When your practice enrolls with HCAI, you are effectively gaining a new way to access patient health information, i.e., through the web. Persons who are assigned a user profile (username and password) are effectively given the “keys” to the information stored electronically in HCAI. Just as you keep close track of the physical keys that open your front door and cabinets containing patient files, you must treat HCAI user profiles with the same diligence. This means that the clinic management should set up processes to:

1. Monitor:
1. Who has a user profile
2. What kinds of information can each user access
2. Manage
1. Provision of appropriate levels of access to each user. It is possible to limit the degree of access by customizing each users access. Clinic owners/operators should take time to understand this process so excessive access is not granted to persons that don’t requre it
2. Activation of new users that will be authorized to access electronically stored health information
3. Deactivation of users who leave the practice so they can no longer access confidential health information
1. Rapid timeframes should be employed (e.g. 24 hours or as established by the practice) in order to minimize the risk
3. Inform
1. Create a list of all users
1. In particular, staff should know which users have the “User Administrator” profile, so they can obtain password resets internally should they become suspended
2. Familiarize users with the capabilities that are associated with their user profile

17. Do I have to send my electronic signature to HCAI?

No. In the OCF 18, Part 5 requests a declaration that the Health Practitioner’s signature is on file. You will not need to attach an electronic signature to the form. There is an expectation that the health practitioner has signed the form and that a copy of the signed form is available if required.

18. How will patients "sign" the OCFs sent to HCAI?

The following OCFs require or offer the option of a declaration that the applicant’s signature is “on file”

• OCF 18 - Part 12
• OCF 22 - Part 9 (optional)
• OCF 23 - Part 5

Note: the declaration is to confirm that the claimant has reviewed the form and that a signed copy of the form is on file and available for authorized parties with appropriate releases. The patient’s electronic signature does not have to be captured nor submitted to HCAI.

19. When preparing multidisciplinary OCF 18s, will HCAI allow me to record multiple signatures?

HCAI will not require you to change your usual practices in this regard. While you do not actually send the health practitioner’s signature via HCAI, you are required to print the OCF form, obtain the health practitioner’s signature and file the hard copy in your Facility. You may continue to collect multiple signatures for one OCF 18; however HCAI has been designed to mirror the paper OCF 18, where only one signature is required. Once you have filed the signed hard copy of the form, Part 5 asks for a declaration that a health practitioner’s signature is on file. For HCAI, you only need to provide one practitioner’s name whose signature is on file, while in fact you may have multiple practitioners’ signatures on the copy of the form that you file within your practice.

20. Why don’t all of the providers appear in all of the dropdown lists in HCAI?

All providers will appear in the dropdown lists as follows:

OCF 18 – Part 12; 
OCF 21B/C – Reimbursable Goods and Services; 
OCF 22 – Part 7
OCF 23 – Part 11

However, only the following providers will appear in certain dropdown lists as follows:

OCF 18 – Part 5 – Health practitioners only (as defined in the SABS)
OCF 18 – Part 6 – Regulated health professionals only
OCF 22 – Part 3 – Regulated health professional
OCF 23 – Part 5 – Health practitioners only (as defined in the SABS)

21. Will the forms be revised to ask the patient/claimant to consent to HCAI receiving the OCF treatment plan or invoice?

FSCO (Financial Services Commission of Ontario) and the HCAI Working Group anticipated this matter. The consent statements have been amended and, together with complementary new regulatory changes, meet all of the related requirements of the privacy laws. The consent statements on the OCF 18, OCF 22 and OCF 23 ask for the patient’s consent to permit personal health information (PHI) to be shared with the insurer. Because the regulation requires the use of HCAI to transmit this data, health providers are protected from privacy violation when they submit PHI to the insurer via HCAI. The consent statement in the OCF 1 and the OCF 23 is much broader and, when signed, allows anonymized information to be used for research purposes. While the OCF 1 will not be transmitted via HCAI, all claimants must sign an OCF 1 to access benefits – in fact, the regulation authorizing HCAI now explicitly says that it must be signed by the claimant or a representative. Health professional associations were engaged in the development of the revised consents.

22. Is a separate consent required by the patient to permit transmission of health information via HCAI?

No. Once a health Facility enrols to use HCAI, the regulation requires the Facility to use HCAI to submit forms to those insurers enrolled with HCAI. Patients do not have the authority to override that law, although they do have the option of submitting the claim form themselves by fax/mail as a means of avoiding electronic submission of their claim information.

Patients (claimants) are not required to use HCAI to transmit claims information; therefore the patient can pay a health facility directly and submit the expense to the insurer him/herself. The insurer will then direct payment to the patient.

While a patient can submit by mail/fax, they may wish to consider whether that is a more or less secure method of transmission. HCAI and its corresponding privacy safeguards were thoroughly reviewed by the Ontario Privacy Commission before the government passed regulations for the HCAI process. Patients may also be interested in knowing that medical records are often sent electronically – (e.g., if the claimant gets an MRI in a hospital it is sent electronically to the physician in the specialist clinic).

23. Will the insurer be required to obtain the claimant's physical consent in order to proceed with an IE?

No. Insurers obtain a claimant’s consent on the OCF 1 and this authorizes the insurer to release information to an assessor. In addition, the OCF 18 and 22 contain consent to release information to an assessor.

24. What is the final date for mandatory compliance with HCAI?

All Ontario insurers were enrolled with HCAI by March 31, 2010. There is no single deadline for health care facilities.

Health care facilities that were previously enrolled with HCAI between April 2007 and March 2008 will be assigned an “effective” date by which they must be ready to use HCAI for submission of OCFs 18, 21, 22 and 23. Effective dates may be in
Tier 1 (April to May 2010), Tier 2 (June to August 2010) or Tier 3 (September to November 2010).

Health care facilities that were not previously enrolled, or are new or are operating under a different name will be assigned an effective date in Tier 3. Check the HCAI Information website for enrolment instructions.

25. What does my practice need to do to enrol with HCAI if it isn’t already enrolled?

In general, the enrolment process is as follows:

Web or PMS Users -

1. Complete the online registration process by following the instructions in the document called “How to Register (HCAI Web Application). This is available from www.hcaiinfo.ca
2. Fax the signed registration details (enrolment form) to 416 497 6505
3. Your clinic will be “Approved” or activated 10 business days before your effective date
4. To learn what your effective date is, check our website at www.hcaiinfo.ca

DEC Users -

1. Contact the HCAI DEC at 1 866 348 9133 and request the registration package.     
2. Complete the package and fax it to the DEC at 1 866 346 6744
3. You willl be able to submit OCF to the DEC on your effective date. To learn what your effective date is, check our website at www.hcaiinfo.ca

26. How do I determine what my effective date is?

Go to the HCAI Full Rollout Schedule and locate your clinic’s name on one of the lists published here. The website will also offer guidance if your name isn’t on any of the lists.

27. My name isn’t on the HCAI Full Rollout Schedule. When do I start to use HCAI?

If your clinic isn’t named in the Tier 1 (published in March 2010), Tier 2 (published in April 2010) or Tier 3 (published in June 2010) lists, you will start to use HCAI in Tier 3, or in the period September to November 2010.

28. Once I am enrolled to use HCAI, will I be able to send fax/mail submissions to HCAI-participating insurers if I don't wish to use HCAI?

No. Health facilities should be aware that, once you are enrolled with HCAI, you must use HCAI to submit OCFs 18/22/23 and invoices to all HCAI-participating insurers. If you do not use HCAI, the plan/invoice will be deemed “not received”.

HCAI-participating insurers are prohibited from paying invoices submitted by HCAI-participating health care facilities when submitted via fax or mail.

29. I submitted a plan to the insurer before my HCAI effective date. May I use HCAI to electronically invoice for services that were submitted to the insurer by fax/mail?

Yes. Consistent with the answer to the above question, once a health care facility is enrolled with HCAI, the facility must use HCAI to submit plans and invoices to HCAI-participating insurers, regardless of whether the prior document was submitted in paper format.

Do NOT resubmit any forms that have already been submitted to the insurer by fax/mail.

30. Does HCAI apply to all NEW patients that are seen by our clinic after our HCAI effective date? Or do we have to use HCAI for all patients, whether they are new or were with us prior to our HCAI effective date?

HCAI must be used for all forms for any patient for whom an OCF 18, 22, 23 or invoice is being submitted. It does not matter if they are an existing or new patient.

31. Will my clinic need to create all OCFs 18/21/22 and 23 using HCAI?

If you have enrolled and the date is on or after your “Effective” date, you must use HCAI for all OCFs 18/21/22 and 23. By March 31, 2010, all Ontario auto insurers will be participating in HCAI; therefore no insurer will be accepting paper forms.

32. Do teachers who deliver educational service to claimants need to enrol with HCAI?

Teachers that deliver educational services to injured claimants may enrol with HCAI; however they may face difficulties finding an appropriately qualified person to agree to supervise the plan (since teachers are regulated under the Education Act and regulated health professionals/health practitioners generally are not).

One option would be for the teacher to submit the “Education Plan” directly to the patient, with instructions for the patient to submit it to the insurer. This plan would not have to be in the format of an OCF 18.

To invoice, please note that Appendix 2 of the HCAI Rollout Guideline excludes academic training from the requirement to invoice using an OCF 21. This means that the teacher can submit an invoice directly to the insurers.

33. Will IBC or HCAI pay for expenses associated with using HCAI?

The online HCAI application will be available to all health care facilities at no charge. For facilities using PMS, IBC has covered the expense of developing an HCAI Integration Toolkit, which was done in consultation with Practice Management Software vendors. This has been provided to any PMS vendor that signs a non-disclosure agreement and will assist the health care facilities using software to seamlessly integrate with HCAI. In addition, a number of workshops have been held with the software vendors and the HCAI team continues to provide support to the PMS vendor community in testing integration.

To determine if there will be additional costs to your facility to use HCAI compatible software, you should contact your PMS vendor.

34. I have 3 sites, or locations, for my clinic. I plan to register all of them. Can I use the same Username when I register each of them?

No. Each Username may only be used once. In the situation as described, you may wish to use a similar Username, but distinguish each in some fashion.

35. AISI Registration versus HCAI Registration

Auto Insurance Standard Invoice (AISI) was introduced in 2002 and was the first attempt to standardize health claims data reporting for auto collision injury claims. At that time, all health providers were required to register in order to receive an AISI registration number so they could invoice insurers for health goods and/or services delivered to people injured in automobile collisions.

AISI registration numbers will continue to be in effect until the HCAI rollout has been completed. It is anticipated that full rollout will be completed by the end of 2010. Once rollout is complete, HCAI becomes universally used by all Ontario auto insurers and health goods and services providers.

36. What does "Lock Payable" mean and what is a "Payee"?

The “Lock Payable” section will determine whether any user at your practice can change the name to which the cheque is issued when an insurance company issues a payment cheque. In most cases, the facility name will be inserted and “locked” so that insurers automatically receive instruction to issue the cheque to the facility. If you do not lock the payable, users who create and submit invoices can change the name to which a cheque is issued.

The Payee first and last names are based on the fields that exist on a paper OCF 21. If you do not currently use these fields, leave them blank. They are not mandatory.

37. I am unable to open the application (www.hcai.ca) to enrol.

In some cases, this may relate to security settings and/or browsers that are not set-up to handle the required 128bit encryption level. Some older browsers may have issues with sites that are “https” and don’t switch automatically if you don’t type in the whole address. Here are two strategies to overcome this

1. Type in the entire address exactly as follows and see if you can get in. https://www.hcai.ca
2. If that doesn't work, go to the HCAI Information website at www.hcaiinfo.ca and click on "Health Care Providers" and then click on "HCAI Enrolment". On that page you will see a link to www.hcai.ca. Try clicking on that link and see if that takes you to the HCAI web application.

38. I am unable to print the enrolment form.

You must have Adobe Acrobat reader in order to download the enrolment form. This is a free download, available from:

39. How can I enter a large number of Providers?

The names of each provider that will be delivering services for the health care facility must be entered individually so their names will populate the health provider dropdown lists that are used for plan and invoice completion.

40. Once I have enrolled, when will my Facility be activated (approved) so I can set up Users?

Your facility will be activated approximately two weeks before your “effective” date.

41. How do I know whom to select for "Contact One" and "Contact Two"? How will their email addresses be used?

HCAI will use Contact One as the main contact to send out information such as outage notifications, notice of new changes, etc. There is no phone number in the Authorizing Officer field but there is in the Contact One field. If the Authorizing Officer has a different number than the main facility number, the facility may chose to enter the phone number of the Authorizing Officer in the Contact One field.

Contact Two is considered a back-up person who would also receive the information that Contact One receives.

42. Is 'Contact One' the main contact that gets e-mail notifications regarding password changes or system maintenance notifications?

Refer to Chapter 3 of the User Manual. The Contact One email address is not used for e-mail notification for password changes. The Authorizing Officer’s address is used for most communications. General communications will also be CCed to Contact 1 and Contact 2.

43. After FSCO announces an effective date for new forms, is there a period during which insurers will continue to accept the old versions of the forms?

Once HCAI rolls out, HCAI may continue to receive old versions of the forms from facilities for a specified time. The HCAI online application will begin using the new forms on the effective date. Facilities that use Practice Management Software (PMS) may need a period to receive and install updated software with the new versions of the OCFs.

44. Signature of Health Practitioner and Health Professional. I am an unregulated health professional. In the past, insurers accepted OCF 18s from me if I had a Health Practitioner sign Part 5 of the form and if I signed Part 6. Can I continue to do this?

No. The regulations expect that, within any facility/clinic/practice, a regulated health professional (either the health practitioner or a non-health practitioner) is available to supervise a treatment plan. If the health practitioner who signs Part 5 is associated with your facility as a “provider”, that person can sign Part 5 (indicating it is reasonable and necessary) and you would indicate that the (supervising) regulated health professional is the same person that signed Part 5 (in which case you do not need to fill in Part 6).

In other words, there are 2 responsibilities that must be assumed; 1.) the responsibility to certify the plan is reasonable and necessary and, secondly, 2.) the responsibility to supervise the treatment. At a minimum, a regulated health professional must be associated as a provider with the facility to take on the supervisory role.

If you are not a regulated health professional, your name does not appear in the drop down list for Part 6. Also, if the health practitioner who signs Part 5 is not associated with your clinic, s/he is not considered to be in a position to supervise treatment. In order to submit plans, you will need to develop a working relationship with a regulated health professional that is willing to be associated as a provider in your practice. This person can then assume (if s/he meets the criteria) the role of health practitioner and/or regulated health professional.

45. HCAI and the SABS Timelines: Does HCAI change the SABS timelines that require an insurer to respond to a plan or invoice in a prescribed time period?

NO. A plan successfully submitted by HCAI prior to 5 pm of a business day is considered to have been received by the insurer on that business day. Refer to the following sections of the Statutory Accident Benefits Schedule for details on the SABS timelines.

46. What is a “business day”?

Consistent with the SABS regulations and applicable law, a Business Day is any day on the calendar from Monday to Friday not including Saturdays and public holidays. Public holidays are Sunday, New Year’s Day, Family Day, Good Friday, Victoria Day, Canada Day, Labour Day, Thanksgiving Day, Christmas Day and Boxing Day.

For greater certainty, Easter Monday, Remembrance Day and the first Monday in August (the Civic Holiday) are not considered public holidays for the purposes of the SABS timelines calculation.

47. What OCF forms are not to be submitted by HCAI? How do I submit those?

Any OCF form EXCEPT for the ones listed below, must be submitted outside of HCAI, as you do now, whether by mail or by fax.

1. OCF 18
2. OCF 22
3. OCF 23
4. OCF 21

Any form that does not appear on the list above must be submitted to insurers using the paper process you used prior to HCAI.

48. I don’t wish to enrol to use the web version of HCAI. How will I submit OCF 18s, 22s, 23s and 21s?

You will have the option to enrol with the HCAI Data Entry Centre (DEC). If that is your choice, you would prepare your forms as you do now and fax/mail them to the DEC. The DEC data entry clerks will enter your data into the HCAI application and, if the data is complete, it will be submitted by the DEC to the insurer. If the data is incomplete, the DEC will contact you within 48 hours and you will return the error report with the additional required data.

49. I entered the name (profession) of a Provider incorrectly and that Provider was activated. How do I correct the spelling error or change their profession?

To correct the spelling of a Provider’s name or to change their profession, you must delete that provider and enter the correct information. Refer to Chapter 3 of the User Manual for instructions on how to delete a provider. If that provider is also a User, you must deactivate the User and re-enter the User information using the correct provider information. Chapter 3 also contains a section that can instruct you on how to deactivate users.

50. How do I change the profession that was selected for a health provider? I mistakenly put Physical Therapy Assistant instead of Physical Therapist.

Refer to Chapter 3 of the User Manual, in the Section called “Adding and Removing Providers”. Once you “end” a version of a provider’s name, it will no longer appear in the dropdown lists on plans; however it will continue to appear on invoices. For that reason, if you enter a provider’s name a second time, try to use a spelling that will permit you to select the right version of the provider.

E.g. John Smith may be entered a second time as John A. Smith.

51. Can I give Plan Submission but not Invoice Submission Capabilities to a user? I would like to give a clerk the responsibility of submitting treatment plans, but I don't want clerks to have the responsibility of submitting invoices.

No. Plans and invoices are treated similarly in HCAI, which means you cannot separate access to plan submission from invoice submission.

52. If I need to learn how to fill out OCF forms and invoices, where can I learn to do this?

The HCAI Information website contains OCF user manuals that you can view online or download. Go to www.hcaiinfo.ca, or, if you require more information, contact your health professional association.

53. If I don't know how to complete a plan or invoice using the HCAI application, where can I learn how to do it?

The OCF Form User Manuals are available at the HCAI Information website (www.hcaiinfo.ca). Identify the way you will be interacting with HCAI, then click on the <Working with OCFs> button.  Once there, click on either the “eLearnings” or “Quick answers.

54. Where can I find downloadable copies of the OCFs and OCF User Manuals?

If you would like to print Word or PDF versions of the OCF forms, they can be downloaded from the FSCO website here: http://www.fsco.gov.on.ca/english/forms/autoforms/claims/default.asp.

The OCF Form User Manuals are available at the HCAI Information website (www.hcaiinfo.ca). Enter the Health Care Facility/Provider portal and you can see links on the left hand side that will take you to the OCF user manuals.

The codes required for completion of the various claims forms (OCFs) can be found at www.hcaiinfo.ca. Enter the Health Care Facility/Provider portal. Along the top is a number of links in blue. Click on the link “Learn to use HCAI/Coding/OCF Forms”

55. Adjudication Decisions: When a plan or invoice is adjudicated, how can facilities keep a record of the adjudication decisions?

After a form (plan or invoice) has been adjudicated, you can keep a record of the adjudication decision by printing or saving a copy of the Adobe PDF version that is in the tab called “ADJUSTER RESPONSE”. The adjudication decision is recorded on the part of the plan/invoice that has the heading “INSURER FAX BACK” for the OCF 18; “OCF 22 FAX BACK” for the OCF 22; “OCF 23/198 FAX BACK” for the OCF 23 and on the last page of invoices, in a box entitled “For insurer’s use only”.

56. What if we don't know which is the correct branch office of an insurance company to send forms?

A branch must be selected to submit the form. Ask your patient or his/her guardian for a copy of the notice that was received from the insurance company that identifies the branch. If this is not available, you can also contact the adjuster. If you are unable to determine which branch to use, select any branch. HCAI will attempt to match the form based on the claim and/or policy number, date of accident, date of birth and gender of the applicant. If a match is not found the receiving insurer may transfer the form to the correct branch.

57. OCF 21: Payment Received from Auto Insurer" amount is not included in calculation of "Auto Insurer Total".

This field is for information only and will not be calculated into the Auto Insurer Total. This is modelled after the paper form (see below) where Payment Received from Auto Insurer is provided for information purposes only. The only field that is included in the calculation is the Interest.

Paper Form:

58. OCF 21A

An OCF 21A can only be used if you have submitted a treatment plan that has been approved. In HCAI, in order to create an OCF 21 A, you must have submitted the treatment plan USING HCAI.  If you submitted the treatment plan on paper (i.e. before you started using HCAI), you cannot create an OCF 21A. You must create an OCF 21 B from scratch.

If you have submitted an OCF 18 USING HCAI, you create an invoice from the submitted plan. This is, in effect, the OCF 21A – although in HCAI it will still appear as an OCF 21B.  To learn how to create an invoice from a submitted plan, refer to the OCF User Manuals. Go to www.hcaiinfo.ca and enter the Health Care Facilty/Provider portal.  On the left hand side are a number of green links. Please review the OCF User Manuals (Web Users).

59. OCF 18 submitted by paper and OCF 21B being submitted electronically. What "Plan #" should be used?

“I submitted an OCF 18 before my facility’s effective date for HCAI, i.e., it was not submitted through HCAI, but by fax. Now I am trying to submit an OCF 21B for the services approved on that OCF 18. In the OCF 21B, Part 3, I am asked for the “Plan #”. Since I did not submit the OCF 18 via HCAI, I do not have a “Plan #”—what should I put in this field?”

In this case, you can use any number that will help you recognize the OCF 18 you're referencing in the invoice. For example, you may wish to use the date the OCF 18 was originally submitted to the insurer.

60. Can HCAI accommodate multi-disciplinary treatment plans (OCF 18s) or assessment proposals (OCF 22s)?

Yes. You can complete a multi-disciplinary plan or assessment proposal, where several practitioners plan to deliver specific services. Regardless of how many different health professions and/or services are being proposed, the forms have sections that are common to all providers that plan to participate in the delivery of services proposed in the form. For example:

OCF 18:
Claimant specific information, which applies regardless of the number of providers, is gathered in:

• Parts 1 - 3,
• Part 7 (Injury and Sequelae),
• Part 8 (Prior and Concurrent Conditions),
• Part 9 (Activity Limitations).

• Part 10 (Treatment Plan Goals, Outcome, Evaluation Methods and Barriers to Recovery).

Note: In Part 10, there is a limit of 500 characters for the narrative text in a) through c).

Selection of health providers is done in:

• Part 12 (Proposed Goods and Services).
  Note: The HCAI version of the form does not have a Part 11 (Health Providers/Social Workers) as does the paper version of the OCF 18. This is because Part 12 has incorporated the selection of health providers that will deliver goods and services.
• Part 12 permits you to list the health interventions and/or goods that your team plans to deliver to achieve the goals listed in Part 10.
• Each service or product (good) that is listed in Part 12 is associated with a health provider. You should select the appropriate provider for each good or service and you may select different providers for different services.

OCF 22
Claimant specific information that applies regardless of the number of providers is gathered in:

• Parts 1 & 2.

• Part 5 (Provisional Clinical Information);
• Part 7 (Proposed Goods and Services).

• Part 7 (Proposed Goods and Services).
  Note: The HCAI version of the form does not have a Part 6 (Health Providers) as does the paper version of the OCF 22. This is because Part 7 has incorporated the selection of health providers that will deliver the assessment services.
• Part 7 permits you to list the health interventions and/or goods that your team plans to deliver to complete the assessment.
• Each service or product (good) that is listed in Part 7 is associated with a health provider. You should select the appropriate provider for each good or service and you may select different providers for different aspects of the assessment.

61. OCF 23 – Does “Responded” mean “Approved”?

No. Responded simply means that the insurance company has determined there is a valid policy in force for the claimant. You must open the form to determine if the costs for treatment and/or goods and services recommended in Part 11 have been approved.

62. When an OCF 23 is adjudicated, it appears to the health care facility as “Responded”. In addition, the HCAI system displays the amounts submitted by the facility as “Approved”. What if the amount submitted exceeds the Superintendent’s fee guideline?

Adjudicated OCF 23s will appear as “Responded” or “Declined”. When an OCF 23 is in the “Responded” state, that implies that a valid policy of insurance is in force and that the insurer will pay for the pre-approved goods and services as per SABS s. 38(8) 1 ii. However, if a health care facility has proposed goods and services in Part 11 of the OCF 23, the facility should review tab 3 of the adjudicated form to determine if the insurer has approved those services.

Also, it is possible to propose PAF fees in Part 9 of the OCF 23 that exceed the Superintendent’s professional services guideline. The insurer is not able to adjudicate the fees proposed in Part 9. This means that if an OCF 23 is in the “Responded” state, the facility should not assume that any fees proposed in Part 9 of the OCF 23, which are in excess of the Superintendent’s professional services guideline, are approved. The agreement to pay for the goods and services is superseded by SABS s. 14(4) and the Professional Services Guideline, regardless of the amounts displayed in the HCAI application.

63. When coding diagnostic imaging on an OCF 22 or invoice, should it be coded as a professional service or as a procedure?

Diagnostic imaging will in most cases be coded as a procedure.

In some instances, imaging services are outsourced by health care facilities to private imaging clinics or suppliers. Regardless of whether the imaging intervention (MRI, CT, etc) is being performed in the facility that generates the OCF 22 or outsourced by the clinic to a sub-contractor, the health professional that signs the OCF 22 must assume responsibility for determining that the imaging modality is reasonable and necessary.

Example: Acme Assessments outsources CT to private imaging clinic

• Treatment provider has concerns about ongoing symptoms that may be suggestive of occult fracture and wonders if diagnostic imaging may be appropriate. Patient referred to Acme Assessment by treatment provider.
• OCF 22 completed and signed by neurosurgeon at Acme Assessments. The neurosurgeon, by signing the OCF 22, is accountable for determining that imaging (e.g. CT scan) is reasonable and necessary.
• On the OCF 22, CT is coded as a "procedure", with the responsible health professional being the neurosurgeon at Acme Assessments.
• CT is outsourced by Acme Assessments to private CT clinic and private CT clinic invoices Acme Assessments for CT procedure (includes CT and radiology report).
• Acme Assessments submits OCF 21 to bill for assessment services including CT procedure.
• Acme Assessments pays private CT clinic.

64. Do I need special software to use the HCAI Web Application?

No. Please refer to HCAI Information website to see what the system requirements are for using HCAI

65. How will I know if my PMS vendor is intending to integrate with HCAI, and when?

The HCAI team has made every effort to contact all PMS vendors that service clinics in Ontario. Some PMS vendors have agreed to have their names published on the HCAI Information Website. You can check to see if your vendor is on this list by clicking here.

If you intend to use your PMS to interact with HCAI, you may wish to contact your PMS vendor to ask what their plans are for HCAI integration.

66. My clinic uses PMS, but it is only used for invoicing. Can I send plans (OCF 18s, 22s & 23s) to HCAI using the Web application, but send invoices (OCF 21s) using my PMS?

Yes. You may wish to speak with your PMS vendor to determine how invoicing will be handled in your practice. However, if you have successfully submitted a form to HCAI using the Web application, the form will be assigned a “document number”. When you prepare your invoice, this document number must be referenced in the invoice in order for HCAI to match the invoice to the right plan.

67. I am an Apple/Mac Computer user. Will HCAI work on Macs?

HCAI is not computer specific, but, rather, is a web-based application. This means that as long as you are able to access the internet with a web browser, you will be able to use HCAI. Below are more details:

• The type and version of internet browser that is used to access the HCAI web application impacts how the user interface behaves more than the operating system or hardware that is being used.
• HCAI has been certified to work with Internet Explorer (IE). The current supported version of IE is version 6 and newer versions (version 7 and 8) have been successful as well.  Although other browsers can function with the HCAI application, there are definitely functions that do not work as they should when compared to IE.
• While we currently don't support browsers outside of IE, we have conducted some additional testing using non-IE browsers (e.g., Safari, Opera and Firefox) and we have also looked at the Mac operating system to provide you with some suggested options when using HCAI.

For the Mac operating system there are two approaches that can be taken:

1. The most direct route to using the web application without issues is by running IE 6 or higher via a Windows boot-partition
1. This can be achived via a product like Boot Camp. Boot Camp is software included with Mac OS X 10.5 Leopard that lets you run compatible versions of Microsoft Windows on an Intel-based Mac
2. Or, a virtual machine using a product like Parallels or vmware Fusion may also help. These options work for Intel-based Macs but not PowerPC based Macs, and require your own authentic copy of Microsoft Windows. To confirm if these options are available for your Mac, you should validate this with Apple support.


2. Although non-IE browsers are not supported, we have done basic testing of Safari, Opera, and Firefox on the OS X platform. All of these browsers run the application with some limitations that may or may not affect your ability to perform work on the system.  We have also observed that some browsers operate more efficiently for some functions than others.  For example, Opera operates better for general navigation and data entry, however it does not print successfully. Firefox 3.5 and Safari print successfully but do not emulate IE as well for screen navigation and data entry so some visual peculiarities may arise when using a non-IE browser.

68. I am using a Mac and am having problems reading the online user manual. Is there another way to access the user manual?

You may download the user manual from www.hcaiinfo.ca. The online manual is not designed to work with browsers other than IE.

69. I am using a Mac and am having problems opening a PDF file.

The ability to download and open a PDF from the HCAI application appears to be linked to the browser version you are using. We have been able to replicate this problem using a Mac in a browser other than IE, but have found that the print functionality does work with Safari 4 and Firefox 3.5. Should using either Safari or Firefox not work, the only remaining workaround for this problem is to use IE 6, 7 or 8 on a Windows partition or virtual machine.

70. How do I clear my “cache”?

If you are using any version of Microsoft Internet Explorer:

1. from your browser menu select “Tools”;
2. from the View drop-down menu select “Internet Options”;
3. on the "General" tab (the 1st one at the top) look for the "Temporary Internet Files" section near the middle of the window;
4. click on the "Delete Files" button;
5. a new window appears, check the little box that says: "Delete all offline content", click the "OK" button—an hour glass tells you that files are being deleted.

If you are using Firefox:

1. click "Tools" and select "Options" on the Firefox menu bar;
2. click the "Privacy Icon" on the Option menu bar to open the Privacy Properties;
3. click "Clear" across from the Cache/Private Data option;
4. click "OK" to return to the browser main page;
5. exit and re-launch the browser.

For users of other browsers, please refer to your browser's documentation on memory/disk caching.

71. Error message. I was using HCAI to create/edit a form and the system suspended and did not carry out the activity I was trying to do. It generated an error message. What should I do when this happens?

Look at the message carefully. If it is a “concurrency” error, that means that two users have been working on the same form simultaneously, and one person saved changes, meaning the other person could not.

The second error is a true error. If this happens, try to obtain a screen capture of the error message (to do this, make sure the error message is showing on your computer monitor.) Using your keyboard, click on the Ctrl+Prnt Scrn buttons, save the image on your computer, then paste it into an email or into a Word document. This may assist in trouble-shooting the error. Then call Helpdesk at 1 888 422 4123 (1 888 HCAI 123) to report the problem. The Helpdesk will coordinate the resolution of the issue thereafter.

72. Can’t submit. I am unable to submit forms because my clinic is in the “Not Approved” state. Why is this?

All facilities are in the “Not Approved” state until they are activated just prior to their effective date. If your clinic has been approved (activated) but has reverted to “Not Approved”, the most common reason for this is that the Authorizing Officer (AO) name has been changed in the FACILITY MANAGEMENT tab. When the AO name is changed, the practice’s contract with HCAI is voided and a new contract must be submitted that is signed by the person who is named in the field “Authorizing Officer”.

73. No “Submit” button. When I am in HCAI, there is a notice that says that I can create forms but I cannot submit them. Why is this?

There are two common reasons for this:

1. The first reason is addressed in the above question and relates to the clinic being in the “Not Approved” state.
2. The second reason is because there are no providers associated with the practice. To check if you have providers, go to the MANAGE global tab and the FACILITY MANAGEMENT sub-tab. Scroll down to “Associated Providers”. There must be at least one provider associated with the clinic.

74. Code descriptions missing. When I print my draft form in order to get the patient’s/health practitioner’s signature(s), the injury or intervention code descriptions are missing.

The codes are not validated until you click on the blue button that says “Confirm Codes”. Prior to printing for the purpose of obtaining signature, click on confirm codes both in the injury code and treatment code sections.

75. Print button doesn’t work. When I click on “Print”, nothing happens.

In order to print downloadable PDFs, your system must permit pop-ups from the HCAI site. To allow this:

1. Open Internet Explorer
2. Go to Tools -> Internet Options. This will open the “Internet Options” window

3. Click “Privacy” tab

4. Click “Sites” under Settings

4. On Per Site Privacy Actions
1. Type www.hcai.ca in Address of Web site: text box.
2. Click “Allow” button

6. Verify that a new entry is added in “Managed Web sites (Domain: hcai.ca, Settings: Always Allow)

7. Click OK, it will close Per Site Privacy Actions
8. Click OK to close Internet Options window

To verify, try to download facility registration details (If your facility is not yet approved). If the facility is approved, try to download any OCF form.

Note: In some cases, the internet explorer might show following message below the address bar:

“To help protect your security, Internet Explorer blocked this site from downloading files to your computer. Click here for options…”

In this case, right click on the message and click “Download File...”.

76. I keep getting a security message as shown below. How do I stop that from happening?

• In Internet Explorer, go to Tools > Internet Options.
• Click the tab that says “Security”.
• Make sure that in the window called "Select a zone..." make sure that that “Internet” is selected.
• Click “Custom Level” and scroll down about half way to "Display mixed content" in the Miscellaneous section.
• Change it from Prompt to Enable.
• Click OK, Yes, and OK.
• The change should take effect immediately.

77. I am not receiving an email with my temporary password.

To ensure you receive passwords from HCAI, please follow the instructions below:

How to Whitelist HCAI Communications

HCAI users should be able to receive email from up to three HCAI-specific addresses:

1. Password resets from systemdelivery@hcai.ca
2. Bulletins and general information from providersupport@hcaiinfo.ca
3. Enrolment questions, responses, issues from facilityenrolment@hcaiinfo.ca

Instructions are provided below for white-listing your mail system. Solutions for many common email service providers are included. If your email service is not listed, review the product's documentation on how to white-list e-mail addresses. Or, if you are using a hosted mail solution, contact your provider to arrange the necessary white-listing.