Interface Options
Insurers have choices for interfacing with HCAI, each with its
benefits and each with its impacts on an insurer’s operations.
The choices, independent of one another, are as follows:
-
Claim and claimant information can be entered manually via the
Web, or via a regular data feed;
-
Regular data extracts from HCAI can be used to update in-house
systems.
-
Insurers may choose to waive OCF 18s and 22s.
- Insurers may submit invoice/payment data via a
data feed.
These features had previously been divided into "core" and
"optional" modules, but are now available to all insurers.
Common Elements
All auto insurers operating in Ontario will be required to
submit claim/claimant
information to HCAI and ensure that all invoice and payment data
gets into the system. The means by which this data enters the system
may vary (see Claim and Claimant and Invoice Options
below). Claims processes will need to change accordingly (some will
take this opportunity to streamline their workflow).
Claim and Claimant
– Data Feed or Manual Entry? 
Insurers are responsible for setting up new claims & claimants
in HCAI (e.g., policy no., claim no., date of accident, claimant ID
and name, date of birth, address, policyholder name etc.)
|
Manual Entry Companies can set up claim & claimant
info manually via the Web.
|
Data Feed
An insurer can build a batch data feed to automatically
transmit claim & claimant information from its claims
management system to HCAI on a regular basis
|
| Benefit &
Impact
Manual entry requires Web access, but no IT resources. A
data feed requires IT resources in the short term to build
the feed, but saves time in the long term. Insurers that
build a data feed will also be able to make approval
decisions knowing that claim and claimant information in
HCAI is accurate, because it comes from their own systems. |
Note: An insurer may choose to enter information manually
until their batch feed is ready.
Data Extracts from HCAI
Companies can retrieve two daily HCAI extracts: 1. new
transactions; and 2. payment info for invoices approved that day.
(The extracts remain on the system for two weeks.) Insurers can use
the extracts to update their claims management systems; update a
data warehouse for analysis; and/or update their financial or
accounts payable systems.
| Benefit &
Impact
For any of the above options, IT resources would be
required to integrate the extracts with in-house systems.
However, the trade-off is that some current processes could
be automated. Insurers not integrating the extracts would
need to a) file a copy of all printed forms and b) manually
update claims management and/or financial systems. |
Note: These extracts are purely optional. Insurers can
choose not to use them at all.
Waiving OCF 18s and 22s
This choice is not specific to HCAI. Insurers in Ontario have
long had the option to pre-approve treatment for an individual claim to a set dollar amount,
and require only an invoice for
payment. This decision is made by insurers on a case-by-case basis. HCAI is designed to accept invoices with no associated
plan. The one exception is the PAF Treatment Confirmation (OCF 23),
which may not be waived.
Invoice Options
In order to maintain comprehensive industry data in HCAI,
insurers choosing to waive a plan are still required to ensure that
invoice and payment data for that claim is recorded in the system.
|
Standard HCAI Process
Regardless of whether a plan is required,
insurers may choose to use the standard HCAI process for
invoices, whereby data enters the system in the course of
online submission and approval.
|
Invoice Data Feed
Insurers may continue to receive
payment requests outside of HCAI, then submit invoice and
payment data to HCAI via an invoice data feed. |
|
Benefit & Impact
Using the standard HCAI process will
require insurers to switch from their current process, but
will allow them to take advantage of efficiencies offered by HCAI's Web interface.
Building an invoice data feed will require IT resources,
but will allow
insurers to continue to process payment requests outside of HCAI,
while satisfying their data requirements within HCAI. |
|
