Intro to HCAI
What is HCAI?
Health Claims for Auto Insurance (HCAI) provides a mandatory and common platform for health care facilities to submit Treatment and Assessment plans (OCF 18s), Treatment Confirmation Forms (OCF 23s), and their associated invoices, as well as Assessment for Attendant Care Needs Forms (the Form 1) to auto insurers for review and adjudication. It benefits patient care and provides the industry with valuable data about automobile claims in Ontario.
Only facilities with an active FSRA Service Provider Licence may invoice the insurer directly. Facilities that are unlicensed cannot be paid directly by insurers but are still required to submit the invoice electronically via HCAI. Unlicensed facilities are required to provide a copy of the HCAI-submitted invoice directly to their patient for the patient to be reimbursed by their insurer. To learn more about Service Provider Licensing, please go to the FSRA website.
What are the benefits?
The HCAI platform benefits patient care and provides the industry with valuable data about automobile claims in Ontario.
Health Care Facilities’ submissions are transmitted quickly and securely
Health Care facilities get a streamlined process for completing Ontario Claims Forms (OCFs)
Health Care Facilities with FSRA’s Service Provider Licence may use HCAI to invoice for direct payment from Insurers
Auto insurance consumers benefit from the speed and accuracy of the data exchanged
Insurers receive more accurate and complete data to assist in adjudicating claims
The Ontario government obtains high quality data and is better positioned to monitor the industry
Who should use HCAI?
Every Ontario health care business (and every associated health care provider) that directly submits OCF-18s, -21s,-23s, and the Form 1 to insurers in Ontario must do so only through HCAI.
Every insurer that writes auto insurance in Ontario is required to enroll with HCAI and comply with regulations and guidelines related to the HCAI system.
For more information on enrolling with HCAI as an insurer, click here.
Who operates HCAI?
The HCAI system is operated by Health Claims for Auto Insurance Processing (HCAIP), a not-for-profit organization established and funded by the insurance industry and operated by an independent board of directors that includes representatives of the insurance industry and health care communities.
HCAI has been designated by the Financial Services Commission of Ontario (FSCO)* as the Central Processing Agency (CPA) for the purposes of fulfilling the role as outlined in the Health Claims for Auto Insurance (HCAI) Guideline.
Insurance Bureau of Canada (IBC) has entered into an agreement with FSCO, and subsequently with HCAIP, which operates the HCAI system, to collect Ontario automobile insurance claims data for statistical purposes.
To learn more about HCAI’s governance structure, click here.
*Effective June 8, 2019, the Financial Services Regulatory Authority of Ontario (FSRA) assumed the regulatory functions of the Financial Services Commission of Ontario (FSCO). Visit www.fsrao.ca for updates.
