With this Bulletin, the Financial Services Commission of Ontario (FSCO) is releasing the Health Claims for Auto Insurance (HCAI) Rollout Guideline. A revised Professional Services Guideline and certain revised accident benefit claim forms are also being released.
HCAI Rollout Guideline
The HCAI Rollout Guideline currently applies only to participating insurers and health care providers. Companies, health care providers and facilities that have not signed up to participate in the HCAI Rollout will continue to use the standard methods of forms delivery set out in the SABS.
It is expected that by February 1, 2008, all insurers and health care providers will be required to participate in the HCAI system. At that time, an amended version of the Guideline will be issued to reflect the requirement.
The HCAI Rollout Guideline is issued pursuant to s. 268.3 (1) of the Insurance Act for the purposes of setting out the requirements for delivery of certain documents under sections 44.1(1) and 68(3.2) of the Statutory Accident Benefits Schedule – Accidents on or After November 1, 1996 (SABS) as amended by Regulation 533/46. The HCAI Rollout Guideline enables the transmission of certain accident benefit claims forms between health care providers and insurers by way of a Central Processing Agency (CPA).
The CPA is the agent designated to receive accident benefit claim forms on behalf of insurers. In addition to receiving forms, the CPA will confirm that forms are completed and then make this information available to the insurers to whom they are addressed. The CPA also enables insurers to communicate claims approval and payment decisions to health care providers.
The HCAI Rollout Guideline:
- lists insurers and health care providers that are subject to the Guideline;
- designates Health Claims for Auto Insurance Processing, an Ontario not-for-profit corporation, as the CPA;
- sets out specific accident benefit claim forms that are subject to this Guideline and that must be delivered to the CPA;
- describes how to deliver documents to the CPA;
- includes rules governing attachments and when documents are considered received by the CPA;
- includes rules dealing with the deemed receipt of documents;
- includes coding information required to complete specified forms and documents; and
- provides other technical details regarding HCAI and the CPA.
HCAI Participant List
Health care providers or facilities that wish to submit and receive information through the CPA must first enroll with the CPA and agree to specific terms and conditions. The terms and conditions deal with confidentiality, security, liability, access and data integrity. Appendix 1 of the HCAI Rollout Guideline provides information on how to access the HCAI Participant List which sets out the names of insurers, health care providers and facilities that are subject to the HCAI Rollout Guideline.
For the full bulletin and attachments, see http://www.fsco.gov.on.ca/english/pubs/bulletins/autobulletins/2007/a-01_07.asp
The Financial Services Commission of Ontario (FSCO) was created on July 1, 1998, as an arm’s-length agency of the Ministry of Finance. FSCO integrates the operations of the former Ontario Insurance Commission, Pension Commission of Ontario, and Deposit Institutions Division of the Ministry of Finance. FSCO comprises three key parts: the Commission; the Financial Services Tribunal (Tribunal); and the Superintendent and Staff. For more information, visit http://www.fsco.gov.on.ca.