Frequently Asked Questions

General

1. What is HCAI?

Health Claims for Auto Insurance (HCAI) is an electronic system for transmitting specific Ontario auto insurance health claims forms between insurers and health care facilities. It supports the need for access to timely, accurate data to monitor the auto insurance system.

2. What kind of transactions are processed by HCAI?

For the time being, HCAI accepts submission by health care facilities of the following Ontario Claim Forms (OCFs):

• Treatment Plan (OCF-18)*
• Pre-approved Framework Treatment Confirmation (OCF-23)
• Standard Invoice (OCF-21)

The system records insurer decisions on each of the above forms. Any other OCF or document will need to be handled outside of the HCAI system.

*When not waived by insurer.

3. Who benefits from HCAI?

Everyone benefits. HCAI aligns two industries - Ontario auto insurers and health care facilities - by providing a common platform for the transmission of Ontario Claim Forms.

• Insurers receive more accurate and more complete data to assist in adjudicating claims;
• The Ontario government gets that same quality data in order to better monitor the system;
• Health care facilities get assistance completing OCF form and expend less time and resources managing insurance forms; and
• Auto insurance consumers benefit from the speed and accuracy of the data exchanged.

The faster patient information can be created and submitted by the health care facility, the faster the patient information can be reviewed by the insurer, the faster patients in Ontario receive treatment for injuries sustained in auto collisions.

4. Who is involved in the HCAI initiative?

The HCAI system is administered by Health Claims for Auto Insurance Processing (HCAI Processing), a not-for-profit organization.

HCAI is an initiative of Ontario auto insurers, who have been working closely with the Financial Services Commission of Ontario (FSCO), the Ontario Ministry of Finance and health care provider associations, to develop the HCAI system.

5. Who is affected by the HCAI initiative?

All Ontario auto insurers, as well as all health care facilities that treat people injured in motor vehicle accidents, are required to use the system once it is rolled out across Ontario. Go to the Health Care or Insurer sections for more information.

Privacy/Security

6. How does HCAI ensure that sensitive health data remains secure?
For the protection of claimant data, all personal information and personal health information in HCAI is encrypted. The HCAI security standard for data transmission is based on permissions linked to usernames and passwords and 128-bit SSL encryption. Insurers and health care providers using the system only have access to claims data for their own patients or claimants. Please refer to the Privacy statement for more information.

7. How can HCAI ensure the integrity of data in the system, given that it is coming from many different health care facilities and insurers?

The HCAI system has a number of features and protocols that verify the identity of all users and validate the quality and completeness of data. Some have already been described above. Others include:

• Each transaction is dated and logged, and insurers receive a copy of the log to check against their own systems.
• As data is submitted or entered into HCAI, it is validated to ensure that codes are valid and mandatory fields are entered. Forms that do not pass the validation rules will not be submitted to the insurer.
• Using claim and claimant information from insurers, HCAI matches forms submitted by providers. Unmatched forms will be forwarded to the affected insurer’s administrator-user to verify or reassign.
• Each insurer and clinic on the system will appoint an HCAI coordinator who will be accountable for managing user IDs and passwords for users.