Health Care Facility/Provider - Web Access - Working with OCF Forms

1. 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 or 23s?

NO! Your signature on the Provider Terms and Conditions form verifies only 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.

2. 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 clinic must keep the signed form on file. Typically, the signed form is retained as part of the patient file.

3. 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.

4. 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-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.

5. 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; HCAI has however 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.

6. Will the OCF 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 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 explicitly states that it must be signed by the claimant or a representative. Health professional associations were engaged in the development of the revised consents.

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

No. Once a health facility's HCAI effective date has taken place, the regulation requires the facility to use HCAI to submit forms to insurers. 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 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).

8. 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, which authorizes the insurer to release information to an assessor. In addition, the OCF-18 contains consent to release information to an assessor.

9. 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?

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.

10. 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 two responsibilities that must be assumed; 1.) the responsibility to certify the plan is reasonable and necessary and, 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.

11. 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 Statutory Accident Benefits Schedule for details on the SABS timelines.

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

Any OCF form that does not appear on the list below must be submitted to insurers using the paper process used prior to HCAI:

OCF 18
OCF 23
OCF 21

13. 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 and eLearning videos that you can view online or, in some cases, download. If you require more information, contact your health professional association.

14. 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 here at the HCAI Information website. Identify your mode of submission (Web, PMS or DEC) then navigate to the Working with OCFs page. OCF Form User Manuals are accessible from this page.

15. 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 codes required for completion of the various claims forms (OCFs) can be found at www.hcaiinfo.ca. Click on the Coding link on the left hand side of the screen.

16. OCF-21: Why is the "Payment Received from Auto Insurer" amount 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 modeled after the paper form where Payment Received from the Auto Insurer is provided for information purposes only. The only field that is included in the calculation is the Interest.

Paper Form:

HCAI:

17. How do I use the 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-21A, 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-21B 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 Facility/Provider portal. On the left hand side are a number of green links. Please review the OCF User Manuals (Web Users).

18. 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 found in the "ADJUSTER RESPONSE" sub-tab.

The adjudication decision is recorded on the part of the plan/invoice that has the heading "INSURER FAX BACK" for the OCF-18; "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".

19. Where do I get an OCF "Plan #" from?

An OCF Plan # (also known as "Document Number") is generated each time you submit a plan via HCAI. This can be located on the Summary tab of the submitted OCF-18.

20. 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.

21. OCF-18 submitted by paper and OCF-21C 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.

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

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.

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).

Treatment planning information for a given plan is gathered in:

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.

23. OCF 23 - Does "Responded" mean "Approved"?

No. Responded simply means that the Insurer has adjudicated the OCF-23.. You must review the relevant sections of the document to learn about the adjudication decision rendered on the OCF-23.

24. What if the amount submitted in an OCF-23 exceeds the Superintendent's fee guideline?

Adjudicated OCF-23s will appear as either "Responded" or "Declined". When an OCF-23 is in the "Responded" state, this implies that a valid insurance policy is in force and the insurer will pay for the pre-approved goods and services as per SABS s. 38(8) 1 ii. If a health care facility has proposed goods and services in Part 11 of the OCF-23, however, 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.

25. 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 "Authorizing Officer" field.

26. 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:

The first reason is addressed in the above question and relates to the clinic being in the "Not Approved" state.
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.

27. 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 the button in both the injury code and treatment code sections.

28. 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>/<Print Screen> 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.

29. Can HCAI accommodate multi-disciplinary treatment and assessment plans (OCF-18s)?

Yes. You can complete a multi-disciplinary plan or assessment proposal, where several practitioners plan to deliver specific services.