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 providers. 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 providers of the following Ontario Claim Forms (OCFs):

• Treatment Plan (OCF-18)*
• Application for Approval of an Assessment of Examination (OCF-22)*
• Pre-approved Framework Treatment Confirmation (OCF-23)
• Standard Invoice (OCF-21)

The system also 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.

• 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 providers expend less time and resources managing insurance forms (patients also benefit from this); and
• Down the road,  consumers could benefit from a more efficient auto insurance system.

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 med rehab providers and facilities that treat people injured in motor vehicle accidents, will be 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 providers and insurers?

The HCAI system will have a number of features and protocols aimed at verifying the identity of all users and validating 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.

Quality Assurance

8. Use of the HCAI system had to be suspended in March 2008. What processes are in place to ensure this does not happen again?

In order to ensure that HCAI is re-introduced only under the highest standards of quality control, the system is undergoing an intensive quality review process at each implementation step. When the system is launched in pilot, certain performance criteria will have to be met before proceeding to add more users and a higher form volume to the system.