Health Care Facility/Provider - Did You Know? - Previous Did You Know Releases

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Coding: Meant to Classify Not Inform Adjudication

Code Descriptions Are Standard (not editable)

The codes are intended only to classify injuries and interventions.

Although the standard description associated with each code may offer some information to an adjuster, by itself the code often does not offer the depth of information an adjuster needs to adjudicate an OCF effectively.

Because many codes reflect a number of different activities, codes are often not intended to tell insurers the exact activity you are referencing.

Example: 7SF12 reflects any or all of the activities below, but its description will only say "Planning, Service"...

Process Overpayment or Credit on the OCF-21

Occasionally, a health care facility may wish to reimburse an insurer for overpayment or to issue a credit. Instructions on how to do this follow:

Go to OTHER INSURANCE, in Tab 4 of the OCF-21 (Figure 1).
Select “Yes -There is other insurance coverage…” option in the I have made reasonable enquiries of the claimant and have determined that: section.
In the “Other Insurer 1”section, enter the name of the auto insurer section in the Other Insurer Name box...

ALL OCF-18s/-21s/-23s Must Be Sent to Insurers & Independent Adjusters Through HCAI

Insurers Not Authorized to Receive OCF Submissions by Fax/Mail

The SABS S.49 and the Health Claims for Auto Insurance September 2010 Guideline no longer authorize insurers to accept fax/mail submissions from health care facilities (HCFs). Please refer to FSCO Property & Casualty Bulletin No. A-01/11 for more information.

All OCF-18s/-21s/-23s submitted by HCFs to insurers must use HCAI. The only exception is when an insurer or claimant representative wishes to audit a signature on an OCF-18 or -23 previously submitted via HCAI...

Completing Line Items for Services that will be Delivered by a Different Health Care Facility

Often, a health professional will refer patients to other health providers and other health care facilities to obtain treatment goods or services that are not available within their own facility.

There are two ways of achieving this using HCAI:

Option 1:
Make the referral and advise the facility to which you've made the referral that they are to prepare and submit the OCF-18.

If the facility to which you've referred does not have a health practitioner associated with them, they may ask for your referring provider to sign Part 4 of the OCF-18.

Option 2:
The prescribing facility can complete the OCF-18. To complete the line for the service to be delivered by the other facility:

Select the code that is appropriate for the prescribed service...

OCF Signatures

OCFs need to be printed and physically signed.
Rules exist for OCF signatures that need to be followed.
We provide clarity around the rules and terms used.

Provider Signing Authority & Facility Association

Each individual OCF form that is completed in HCAI should be printed and signed by the certifying or supervising Provider...

Outstanding Invoices & HCAI

There are two aspects to collection on outstanding invoices: (I) collecting the outstanding amount that has been invoiced, and (II), collecting interest charges on the outstanding amount.

Collecting outstanding invoiced amounts

Do NOT submit duplicate invoices. Collecting outstanding invoices should be done by means of a "Statement" rather than an invoice.

A statement can be submitted to the insurer by fax/mail as it is not an OCF and, therefore, cannot be submitted through HCAI.
A statement may include a COPY of the original invoice.

Collecting 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 then 30 days ago.
Charging interest on outstanding amounts owed to your facility can be done in one of two ways, depending on whether the patient is still receiving services at your clinic or not.

Provider ID Required (for PMS Users)

This bulletin is being sent to all health care facilities (businesses/clinics/ practices) that are already using HCAI and that use Practice Management System (PMS) software to interface with HCAI. If you have a question about PMS, please refer to:

http://www.hcaiinfo.ca/Health_Care_Facility_Provider/PMS_Access/index.asp.

Many health care facilities that use PMS software to connect with HCAI report that their system gives them an error message: "Provider ID required" when trying to submit forms via HCAI. This resource quickly describes how to avoid this error.

Make sure your facility is in the "Approved" state.

Verify in the Facility Detail screen that your facility is in status 'Approved', which means that you are able now to submit forms to HCAI (see figure 1)....

Reset Suspended User Accounts Independently

You Can Easily Reset Suspended Users Yourself

You don’t need to contact HCAI Support when a user becomes suspended.
Suspended HCAI Users often have the ability to reset their own accounts.
Every health care facility has the ability to reset passwords for suspended Users.
Password reset requests to HCAI Support will be returned with instructions describing how you can reset passwords yourself.

When a valid email address is attached to an individual’s HCAI User profile, the User simply clicks on the <Forgot Your Password?> text-link to reset the password...

Keep Your Email Addresses Current

Email addresses are important in HCAI to facilitate:

Communication about Auto Insurance issues; and
Password resets.

This bulletin explains how to keep those email addresses current so you and your users will continue to receive email communication and password resets when required.

Communication

In the auto insurance health system, there are often changes or new information that will assist you in running your practice as efficiently as possible. At HCAI Processing, we will communicate these changes in a couple of ways:

HCAI Info website - www.hcaiinfo.ca;
Emails sent to the Authorizing Officer and Contact One.

How to Locate Forms and Navigate HCAI

When a plan has been submitted, it will reside in your Work In Progress sub-tab (Plans or Invoices global tab and Work In Progress sub-tab).

Forms located in the Work in Progress tab can appear in a variety of states. To learn more about the different states, refer to Chapters 4 and 6 of the online HCAI User Manual.

You can access the HCAI User Manual by clicking on the words "User Manual" at the top right corner of any www.hcai.ca webpage.

A submitted form can be in a number of “states” including:

Submitted (the insurer has received the form)
Review Required (the insurer has started but has not finished reviewing the form)
In Discussion, Response Required (the insurer has a question for you)
Amendment Required (a change or correction needs to be made on the form)

Provider Hourly Rates

HCAI now allows health care facilities to insert default hourly rates in the profile of associated health care providers.

When a default hourly rate is inserted into a health care provider’s profile, HCAI will do the calculations on the corresponding line items in a plan or invoice.
If the default hourly rate is not inserted into the provider’s profile, the calculations must be done manually.

Inserting the Provider’s Default Hourly Rate

To insert the default hourly rate into a provider’s hourly rate, the health care facility’s Administrative Officer will go to Manage > Facility Management sub-tab.

Scroll down to the bottom of the page to the "Associated Providers" section. Click on the name of the provider for which you wish to insert the default hourly rate.

If you are adding a new provider to the health care facility, click the <Add Provider> button at the right hand corner of the "Associated Providers" section.