Insurers - Did You Know? - Previous Did You Know Releases

When translated into a PDF file, the last page/tab of the Ontario Claim Form (OCF) may not be displayed.
If all tabs are not displayed in the PDF version of an OCF, a screen print must be executed.

Impacted OCFs

If the health care facility has not checked the “Attachments being sent, if any” box in the Additional Comments section of an OCF, the final page/tab of the PDF version may not display...

You Can Increase HCAI's Speed

HCAI's performance is directly impacted by the behaviour of its users.
What you do or don't do affects how quickly HCAI performs the tasks you request.
Below are a couple tips that will improve your HCAI experience.

Log Out & Log Back In

When you are using HCAI and you notice that the system isn't moving as quickly as it was for you when you logged in, there is a simple way you can improve the application's speed: log out...

Health Care Facilities - Make Cheque Payable Field

Adjusters or support workers who are issuing payments outside of HCAI should always review the Make Cheque Payable To field of the OCF21B/C. This field indicates to whom payment should be directed.

Health care facilities have the ability in HCAI to inform insurers about the specific name to whom a cheque should be made payable.

When a Health Care Facility sets up its practice in HCAI, the Facility may choose to lock the Part 4: Payee Information section in an invoice (OCF-21B/C)...

Use of Pending Status in HCAI

As experience with the HCAI system matures, best practices for use of specific functionalities within the system will evolve.

This is the case with HCAI's Pending functionality.

Previously, some insurers requested a Pending function in the HCAI application to accommodate scenarios where decisions could not be made on a submitted OCF-18. Possible reasons for using Pending included failure to submit an application for Accident Benefits (OCF-1) or when a disability certificate (OCF-3) had not yet been received...

Transferring Claims and Claimants within the HCAI system

The HCAI system was built so that claims and claimants are associated with a specific Branch of the Insurance Organization.

Conceptually, the flow of information from the business perspective looks like this.

Once a claim has been created within a Branch, the claimants will be assigned to adjusters associated with the Branch.

Claims and Claimants cannot be transferred from one Branch to another.

There may be times when Insurers need to have claims and claimants handled by an adjuster outside of the Branch to which the claim has been assigned.

There are a several ways this can be accommodated in HCAI. The following pages describe three possible options.

HCAI - Data Entry Centre (DEC)

HCAI's Data Entry Centre (DEC) has undergone successful User Acceptance Testing and is ready to launch into its pilot phase beginning August 3rd, 2010. The DEC pilot will be controlled with only a few Health Care Facilities (HCFs) participating.

DEC enrolment is anticipated to increase in Tier 3, which is scheduled to begin October 4th, 2010. Upon receipt of paper OCF forms from HCFs via fax or mail, the DEC will enter data from the forms into HCAI, where the electronic versions of forms may be viewed by insurance adjusters through the Web.

Important information regarding the DEC:

Prior to submitting OCF forms to the DEC, a facility must enrol with HCAI.
HCFs may submit forms to the DEC by mail or fax.
OCF forms that are received after 5:00pm will be deemed to be received on the following business day.

Health Care Facilities & HCAI Effective Dates

Every health care facility (HCF) participating in HCAI is assigned an effective date by the Financial Services Commission of Ontario (FSCO). FSCO publishes each HCF’s HCAI effective date in the HCAI Participating Provider List, which is updated every month.

The HCAI Participating Provider List is located at the FSCO website.

Once a HCF’s effective date has arrived, the HCF must submit forms via HCAI in accordance with the date specified in the HCAI Participating Provider List.

Health Care Facilities & the HCAI 2010 Rollout Guideline

FSCO issued the HCAI 2010 Rollout Guideline on May 12, 2010. The Guideline took effect on May 22, 2010. The Guideline can be accessed at the FSCO Website.

User Administrators and Back-up User Administrators

The User Administrator role should be assigned to the individual(s) in the insurance organization that will be responsible for the setup and ongoing management and maintenance of users in HCAI.

The User Administrator role could be assigned to the same individual who performs the role of Organization Administrator.

Alternately, the User Administrator role could be provided to an IT Helpdesk staff member who is assigned the ability to create new users and maintain existing users in HCAI.

HCF Enrolment

Unlike Insurers who adopted the system by March 31, 2010, the Health Care Facility (HCF) enrolment process continues throughout 2010. HCF enrolment in HCAI is being implemented in tiers.

Tier 1 has been provided with dates from April 19th to May 31st, 2010
Tier 2 will run from June 1st until August 30th, 2010
Tier 3 will run from September 1st to November 29th, 2010

Each HCF will be assigned an effective date, which they can look up on the www.hcaiinfo.ca website.

Currently, only those HCFs that have been assigned an effective date between April 19th and August 30th are listed.
In mid-June, the Tier 3 list will be posted with instructions for all remaining
(non-Tier 1 or 2) HCFs.

Searching For Forms

From time to time an adjuster may receive a call from a Health Care Facility requesting a discussion about a particular OCF form or invoice that either the facility has submitted or the Insurer has adjudicated.

Searching for a form in the "Work in Progress" or "Adjuster Response" sub-tabs can be time consuming, especially as an adjuster's form volume increases. The fastest and most responsive method to search for a document is to use the "Search" tab.

If the Health Care Facility can provide the adjuster with the document number, this is the most accurate way to narrow your search. The Health Care Facility will find this number displayed in various places in a particular document. Most notably, the document number is displayed on the Summary tab in the "Plan Details" section... Read More

Cannot Be Matched

Sometimes a form may be sent to an Insurer in error by a Health Care Facility. To ensure that facilities are aware of the proper Insurer and corresponding Branch to which OCF forms should be sent, it is important for all Insurers to communicate actively with the facilities that are treating claimants.

When an OCF form has come to your company in error, it will only be viewable to Users with Branch level access. The form will have the status of "Unmatched".

To send the form back to the Health Care Facility, the Insurer-user must have the Plan/Invoice Adjuster role. Click on the magnifying glass beside the notification and HCAI will bring you to the "Match Claimant" screen. Click on the <Cannot be Matched> button as shown in the screen shot below... Read More

Access Methods

There are three ways for Health Care Facilities (HCFs), i.e., health practices or clinics, to access the HCAI system:

Through a Practice Management System (PMS);
Using the Web application at www.hcai.ca;
Complete a paper form and send via the Data Entry Centre (DEC).

Insurers will always view information via the web application... Read More

Navigating HCAI

When most users enter the HCAI application they are brought to the Plans > Work In Progress sub-tab.

Adjuster-users should enter the HCAI web application at least once every business day to check for new OCF form submissions.
When checking for new forms, the adjuster-user should click on both the Plans and Invoices tabs to locate new submissions in his/her Work In Progress work-list.

Every HCAI user that works directly with OCF forms—e.g., adjusters, adjuster support staff—has the option to sort the information that is contained within his/her respective work-list. Sorting takes place by clicking on one of the column headings contained in the Work In Progress work-list.... Read More

Privacy

In order to perform its function as an electronic interface between insurers and health care facilities, the HCAI system contains sensitive "personal health information" (PHI) and "personally identifiable information" (PII). Protecting this information is the responsibility of HCAI Processing, health care staff, insurer personnel and claimants... Read More