OCF-18 Treatment and Assessment Plan

Part 1: Applicant Information

This section contains details about the claim, and information about the Patient. The Applicant (Patient) or Substitute Decision-maker should provide this information. (View screenshot)

Please note: Carefully entering Claim Identifier and Applicant Information is important for matching purposes. View Submitting and Storing forms for more information on matching.

Claim Identifier

1. You must enter either a claim number or a policy number. Only one of these numbers is required, not both. However, if you have both claim and policy number, it is helpful to insert both for matching purposes.

2. Enter the date of the accident using the calendar tool, formatted as shown.

Applicant Information

1. The following fields are mandatory: Date of birth, gender, first and last name, address, city, province, and postal code.

Part 2: Auto Insurer Information

This section includes the Patient’s automotive insurer details. The Applicant (Patient) or Substitute Decision-maker should provide this information. (View screenshot)

Remember: All OCF-18s must be submitted via HCAI. Insurers and Independent Adjusters cannot receive the OCF-18 via fax or mail.

1. Select the insurance company to whom this form will be sent. Use the drop-down list and select from the available companies.

   • Please note: 100% of insurance companies are enrolled and using HCAI. Please be aware that independent adjusting firms will not appear in this drop-down list because they are not licensed Insurers. To direct claim forms appropriately, HCFs should determine (typically by asking the patient or the Independent Adjuster) the name of the licensed Insurer that is managing the claim.  

2. Indicate whether the policy holder is the same person as the applicant.

   • If the patient is the person who holds the insurance policy, select “Yes”.

   • If the patient is not the policy holder, select “No”. For example, a child who has been injured in an accident would likely have coverage under his parents’ policy. In that case, enter the last name of the policy holder.

3. The last name of the policy holder is mandatory if the policy holder is not the same as the Applicant

Part 3: Other Insurer Information

1. The Applicant (Patient) or Substitute Decision-maker should inform the Facility if there is other insurance. (View screenshot)

   • Facilities are not responsible for errors or omissions in information provided to them by the Patient or Substitute Decision-maker.

   • The Auto Insurer is not liable for any costs that are payable by any other Insurer.

   • The system used by Auto Insurers requires other insurance plans to be accessed before auto insurance health benefits are accessed.

   • Health benefits may also be available from the Ministry of Health and Long Term Care (MOH) or through an Applicant’s (Patient’s) personal, spousal or parental extended health plan. These extended benefits may pay or partially pay expenses listed in the form.

2. Space is available for two other Insurers in the event that the Applicant is covered by more than one policy (for example, if both the Applicant and the Applicant’s partner or Legal Guardian have extended health benefits).

Part 4: Signature of Health Practitioner

Please note: Health Practitioners are not to sign blank forms.

In order to sign the OCF-18, the Health Practitioner’s profession must be one of the Health Practitioner professions listed in the Statutory Accident Benefits Schedule. The Health Practitioner (HP) who signs Part 4 does not have to be employed/associated with your Facility.

1. If the HP is associated with your Facility, use the drop-down menu to select their name from your Facility’s Provider list. If the HP’s name does not appear on this list, this is for one of two reasons:

   • The HP has not yet been added to your list of Associated Providers in HCAI. Click here to learn how to add a provider.

   • If the provider is on your list of Associated Providers in HCAI but their name still does not appear in Part 4, the provider is not a profession that is authorized to sign Part 4. See the Statutory Accident Benefits Schedule for the list of Health Practitioner professions.

2. If the HP is not associated/employed with your Facility, they can still sign Part 4. If the Health Practitioner is external to your facility, select “Other” in the drop-down menu next to “Name of Provider”. (View screenshot)

   • Enter the Health Practitioner’s detailed information, including Name, Profession and College Registration Number.

   • When selecting “Profession”, only professions that are authorized to sign Part 4 will appear as options in the drop-down list.

   • If “Other” is selected here, you must then fill out Part 5: Signature of Regulated Health Practitioner.

Is this injury subject to a guideline?

• If the impairment is not predominantly a minor injury as referred to in the MIG, select “No”.

• If the date of accident was before September 1, 2010, select “Not Applicable” to indicate that injury is subject to the Pre-Approved Framework.

• If the impairment is predominantly a minor injury as referred to in the MIG, select “Yes”. (View screenshot)

• A new field labelled “Circumstance” appears. Use this field to select the applicable circumstance for why an OCF-18 is being submitted

• If the second Circumstance is selected, an explanation must be provided in the text field that appears.

• You may indicate that you will be sending attachments as documented evidence for the pre-existing condition. Any attachments must also be mentioned in the final section of the OCF-18, Additional Comments.

Declare that the signature of the Health Practitioner is on file

In this section, the HCAI web application displays brief attestation wording. Full consent language is only viewable on the paper or PDF versions of the OCF-18. (View screenshot)

Once the OCF-18 is complete, it must be printed, reviewed, and physically signed by the Health Practitioner (and Regulated Health Professional, if applicable) and stored in the Applicant/Patient file at your facility. The Insurer or FSRA may ask to see it.

1. Select the “Yes” or “No” radio button to indicate that the signature is on file and the OCF-18 has been reviewed by the practitioner. The OCF-18 cannot be submitted unless the answer to this question is “Yes”.

2. Use the drop-down calendar menu to indicate the date the form was signed.

Is the health practitioner also the regulated health professional?

1. Select “No” if the Health Practitioner is not going to supervise the treatment plan. Part 5 will appear and must be completed.

2. Select “Yes” if the Health Practitioner is in your Providers list and is going to supervise the treatment plan. Part 5 will not be displayed.

If the Health Practitioner who signs Part 4 is not associated with your facility, then “No” is automatically selected as the answer to this question, as the Regulated Health Professional who signs Part 5 must be associated with your Facility. You must complete Part 5.

Part 5: Signature of Regulated Health Professional

Only a Health Practitioner or a Regulated Health Professional can sign Part 5 of the OCF-18. Unregulated Health Professionals may not sign the OCF-18. Although the Regulated Health Professional signing Part 5 does not have to be employed by your Facility, they do need to be associated with your Facility as a Provider in HCAI (Click here to learn how to add a Provider to your list in HCAI). You will not have the option to select “Other” in this section. (View screenshot)

Regulated Health Professionals

In some cases, the Health Practitioner who signs the form may not prepare the form or may not be the appropriate professional to supervise the plan.

Example: A Registered Massage Therapist (RMT) may prepare an OCF-18 for massage therapy.

• The RMT will be required to sign Part 5 and supervise the treatment.

• The RMT must arrange to have a Health Practitioner sign Part 4.

• Part 4 may be signed by a Health Practitioner who is not associated with the Facility (e.g., a family physician) or it may be signed by an associated Health Practitioner (e.g., a physical therapist on staff at the Facility).

Associated Providers

The term “Associated” applies when a Health Professional is registered in HCAI as a Provider for the Facility that plans to invoice for the services.

• This Provider will be listed in the Facility’s HCAI Provider List.

• The Associated Provider will be able to sign OCFs and/or deliver care to Patients of that Facility on behalf of the Facility.

• Click here to learn how to add a Provider.

Filling out Part 5

1. Select the name of the Regulated Health Professional who will supervise the plan.

2. Select “Yes” or “No” in response to the question ‘Is the signature on file?’

3. Insert the date on which the signature of the Regulated Health Professional is obtained.

Signatures are not electronically transmitted to the Insurer. Hard copies of the form must be printed, signed and kept on file at the HCF with the Patient record. If requested by the Insurer or Applicant (Patient), the signed hard copy must be produced.

By checking “Yes” to Is the signature on file? the Health Professional certifies the following:

• The form has been printed and signed by the Regulated Health Professional, and the signed hard copy is available at the HCF.

• The goods and services proposed in the treatment plan are reasonable and necessary for the injuries described in Part 6.

• The signature of the Regulated Health Professional in Part 5 does not imply that the signee is professionally liable for the actions of other Health Professionals listed on the form.

• Before signing Part 5, confirm that the requirements for informed consent have been met.

The inclusion of a revised statement of understanding identifies, for the initiating Regulated Health Professional, the range of specific uses that will be made of information related to providing services to injured Auto Insurance Claimants.

Part 6: Injury and Sequelae Information

Injuries or problems are coded using the standard descriptions from the International Classification of Disease, 10th Revision, Canadian edition (ICD-10-CA).

Visit the Coding page or watch the Injury Coding Basics video for more information. Furthermore, call your health professional association to find out if they have developed an injury code list specific to your profession.

The purpose of Part 6 is for the HCF to code the complaints, injuries and sequelae that are a direct result of the automobile accident and the most responsible for the services proposed in the plan (e.g. S42.0 – Fracture of clavicle; Z58 – Problems related to physical environment).

1. Use the HCAI search utility to search for injury/sequelae codes. (View screenshot)

2. List each code only once, regardless of how many Health Professionals will be engaged in treatment.

3. The first line item should reflect the primary reason or problem that is most responsible for the proposed services.

   • Example: If psychological services are required after a brain injury, the first code listed should reflect the reason that psychology services are being proposed. F07.2 – Postconcussional Syndrome, and then S06 – Concussion.

   • In a case where multiple injuries may be classified as the most significant, list the injury requiring the most services first.

4. An injury that has resolved (e.g., a healed fracture) or a condition that is not responsible for the services in the plan, should be listed last; alternatively, that injury or condition can be relegated to Part 8 “Prior and Concurrent Conditions” (i.e., a resolved problem can be considered a prior problem).

   • Example:  Original injury is S73 – Fractured femur. The surgeon reports that the fracture is healed. The femoral fracture is resolved, but ongoing treatment is required to manage pain and gait re-education. In this case, the problems listed could be:  M79.6 – Pain in limb; and R26 – Abnormalities of gait.

5. To provide the Insurer more information regarding the Applicant’s (Patient’s) injury, problem or circumstances, use the comment sections in Part 12 or in Additional Comments.

Injury/Sequelae Coding for Assessment Proposals

Each assessment proposed is presumed to be required to address a complaint, injury or sequelae

1. Code the complaint, injury or sequelae that has led to the requirement for an assessment.

   • Example 1: Patient reports persistent low back pain that is not responding to treatment. Problem may be coded as M54.4 (Low Back Pain)

   • Example 2: Patient is unemployed and vocational evaluation being proposed to facilitate RTW. Problem may be coded Z56 (Unemployment; unspecified).

Questions about coding

If you have questions about which injury code(s) to use, contact your health professional association. HCAI support staff do not have medical training and are unable to offer guidance on any topic other than the use of the HCAI application.

Common codes

• Single physical injury – refer to S codes. (e.g. S42.0 – Fracture of clavicle)

• Multiple injuries and bilateral injuries – refer to T codes (do not list duplicate codes for bilateral injuries).

• Mental and behavioral disorders – refer to F codes.

• Symptoms, signs and abnormal clinical and lab findings not elsewhere classified – refer to R codes.

Adding additional lines for injury/sequelae codes

1. If more space is required for additional injuries or problem codes, extra lines may be added. Click the + button at the bottom right of Part 6 to add additional lines. (View screenshot)

Part 7: Prior and Concurrent Conditions

This section is to help the Insurer better understand the Applicant’s (Patient’s) condition before the accident. It informs the Insurer of any pre-existing condition(s) that may affect the Patient’s response to treatment, and it provides additional information around circumstances that may affect recovery. (View screenshot)

1. Provide relevant information to the best of your knowledge and based on information from the Applicant. A response of “Unknown” may prompt a request for further clarification from the Insurer.

2. If you are aware that a Patient will receive treatment for a concurrent condition, document the treatment in Part 9.

3. If more space is required, use Additional Comments on the last tab of the form.

Part 8: Activity Limitations

This section will help the Insurer understand if the Applicant (Patient) will experience any activity limitations related to employment or daily living. The responses are based on current knowledge of the Health Provider and information provided by the Applicant (Patient). (View screenshot)

1. If any responses to the questions in Section (A) are “Yes,” provide a brief description of the activity limitations the Applicant (Patient) is experiencing.

2. A response of “No” in Section (C) will require further explanation and may require contacting the employer; however, it is not intended to signify the need for a job-site assessment.

Part 9: Plan Goals, Outcome Evaluation Methods and Barriers to Recovery

This information will assist the Insurer to determine if and to what degree progress has been made upon completion of the treatment plan. (View screenshot)

The information in Part 9 should be consistent with the intervention codes provided in Part 12.

Part 10: Signature of Applicant

The Insurer may elect to waive the requirement for the Applicant’s (Patient’s) signature, but this must be ascertained in advance. (View screenshot)

1. Review the completed treatment plan with the Applicant (Patient) or Substitute Decision-maker.

2. To print the OCF-18 click the “Print” button at the top or bottom of the form in HCAI.

3. The consent for the use of information has been revised to reflect the current privacy legislation and other legislation with which Insurers must comply. Insurers are responsible for ensuring that Applicants understand these conditions when initiating a claim through the submission of an OCF-1.

4. If the Applicant requires more information about the consent and corresponding obligations, please refer them to the Insurer handling the claim.

Part 12: Proposed Goods or Services Requiring Insurer Approval

In this section, enter all the Goods and Services planned that require insurer approval. (View screenshot)

Code

This section uses CCI (Canadian Classification of Interventions) codes or GAP (Goods, Administration, and Other) codes, as well as Unit Measures and Provider Type codes. The OCF-18 does not allow Minor Injury Guideline (MIG) codes.

• GAP Codes (PDF)

• Provider Type Codes (PDF)

• Unit Measures (PDF)

Visit the Coding page or watch the Treatment Coding Basics video for more information.

1. Enter the intervention code by typing it directly into the field or use the code search utility by clicking the “...” button next to the “Code” field.

2. The “Search Goods and Services Codes” window opens. Select either “CCI” or “GAP”. (View screenshot)

   • CCI are international standard codes for health interventions.

   • GAP codes were developed by Insurance Bureau of Canada with the help auto insurers and health care providers, and can be used for services that are not well reflected in the CCI, such as:

     • Administrative services such as travel time and mileage

     • Pre-claim examination

     • Goods and Supplies

     • Health Provider Initiated Examination & Insurer Initiated Examination, including Attendant care, Catastrophic, Disability (Pre 104 weeks and Post 104 weeks), Combined (MedRehab and Disability), and MedRehab

     • Telephone consultation with other Health Providers

3. Once you have selected CCI or GAP, the Section drop-down menu will populate.

4. Pick a Section in order to have the Intervention drop-down menu populate.

5. Pick an Intervention in order to have the Group drop-down menu populate.

6. Select a Group and hit the “Search” button.

7. The search results appear. To add a code to your plan, click the “Add” button.

Attribute

1. In addition to the CCI codes, health care services can be further specified with “Attribute Codes”. These codes are used to indicate how the service was delivered, such as the number of views in an X-ray study.

   • The absence of attribute codes means that the service was rendered directly (in person) to one individual by one individual Provider and required continuous attendance.

Provider Reference

1. To select the Provider who delivered care, click on the “...” button to open the Select a Provider window. If more than one Provider delivered care, list only the one who was most responsible for each visit and who will be most likely to be listed on the invoice.

2. Use the drop-down menu to select the Provider. Use the Profession drop-down menu to select the applicable profession if the Provider has more than one assigned in HCAI. (View screenshot)

3. If the Provider has a default hourly rate assigned, that figure will also appear.

To insert the same Provider(s) for multiple line items:

1. Complete all fields except for “Provider Reference”.

2. Check the box to the left of each completed line item that you wish to assign the same Provider(s) to (View screenshot).

3. Click the “Apply Providers” button and select the name of the Provider(s) from the dropdown list.

Quantity/Unit measure

1. Enter the quantity and unit measure of service that will be provided during a single treatment visit/session. For example:

   • 15 minutes = 0.25 HR

   • 1 procedure = 1 PR

   • 1 good (such as a back support) = 1 GD

   • 10 km = 10 KM

   • 1 session = 1 SN

   • Click here to view more about Unit Measures (PDF)

Cost

1. HCAI allows Facilities to enter a default hourly rate for each Provider using the Facility Management tab (click here to learn how). This can be used to calculate the cost per line of treatment. If the Measure assigned is HR, the default hourly rate will appear in the Cost field.

2. You may click on the “Calculate costs from rates” button to override the value in the Cost field for any measure of HR or KM and assign the default rates.

3. If the selected Provider does not have a default hourly rate assigned, or you need to use a different rate, enter the value in the Cost field.

4. Be sure to report the cost per service as the service is described in the line.

   • For example: 15 minutes of massage or 0.25 HR by a Massage Therapist = 25% of the RMT’s hourly fee.
     

Facilities may charge fees in excess of the Superintendent’s Professional Fee Guideline, but Insurers are not required to pay fees that exceed that Guideline.

Create a Session

If one Provider delivers multiple treatments to a patient during a single visit, you should create a session. If not, you can continue on to Total Count (View screenshot).

1. To create a session, complete the fields described above for each proposed good/service, and stop before entering Total Count.

2. Select the checkbox to the left of each line you wish to include in the session.

3. Click the “Create Session” button located at left.

4. HCAI automatically creates a session for the selected lines. Complete the “Total Count” field for the session and then continue the rest of Part 12.

Total Count

1. Enter the total number of times the service will be delivered during the course of the treatment plan.

   • For example: If a treatment is to be delivered twice per week for 6 weeks, the total treatment visits is 12. If the exercise will be delivered during each visit, then the Total Count = 12.  If the assessment will only take place once during the 6 weeks, then Total Count = 1.

Proposed Tax

1. If Tax is applicable to a line item, check the box in the “Proposed Tax” column.

Complete line items for services delivered by a different Facility
If you’ve referred a patient to another Facility to obtain treatment goods or services that are not available within your Facility, you (the prescribing Facility) can include this line on your patient’s OCF-18. To do so complete the following steps (View screenshot)

1. Select the code that is appropriate for the prescribed service.

2. Reference the Provider at your Facility that is making the prescription/recommendation for the external service.

3. Enter the cost for the service at the external Facility’s rate, not at the prescribing Facility’s rate.

4. Provide a note in the narrative section of the OCF to explain to the insurer that the services are prescribed by this Facility but will be delivered (and invoiced) by a different Facility.

Add more items

1. To add lines for additional goods and/or services, select the number of lines you wish to add using the “Add more items” dropdown list just above the “Calculate Costs from Rates” button, then click the “GO” button.

Duration

1. Enter the anticipated duration of the treatment plan and indicate how many treatment visits have already been delivered for this plan.

Consent

1. Indicate whether the Applicant or Substitute Decision-maker has confirmed consent for the proposed goods and services using the “No” or “Yes” radio buttons.

Totalling

In the Totalling section, the following values appear: (View screenshot)

• Total Count is the sum of the count of all proposed goods and services calculated by HCAI.

• Sub-total is the sum of the cost of all proposed goods and services calculated by HCAI.

• Minus MOH is the sum of all Ministry of Health and Long-Term Care amounts that are payable to you for any of the goods and services listed above.

  • Insert a minus sign (-) before the dollar amount payable to ensure this sum subtracted from the sub-total.

• Minus Other Insurer (1 + 2) is the sum of all amounts payable to you from other Insurers.

  • Insert a minus sign (-) before the dollar amount payable to ensure this sum is subtracted from the sub-total.

• Tax is the total Proposed Tax for all goods and services listed above.

• Auto Insurer Total is the sum of all amounts in this section.

Calculate

1. When all of the proposed goods and/or services have been entered and all fields in the Totalling section, click “Calculate”. HCAI calculates Tax (HST) and enters the amount into the Auto Insurer Total.

2. If you wish to change the prepopulated HST amounts, Click and uncheck the "Check" button underneath the Totalling box labeled “Recalculate proposed tax to reflect HST on selected taxable items.”

3. Enter the new tax amount in the “Tax (if applicable)” field.

4. Click “Calculate” to generate a total with the new amount.

5. Use the empty text field space below the Totalling section to provide more detail about the proposed goods and services if the codes do not offer enough details. If more space is needed, you may also use the Additional Comments section in Tab 6.

Additional Comments

The Additional Comments section allows the facility to offer additional information about the Applicant, their injuries, care, treatment, response to treatment, or anything else that will help the Insurer understand the Applicant story.

1. You can cut and paste plain text—from a Word document, for example—but you cannot copy and paste complex tables, charts, or images.

   • There is a limit of 20,000 characters.

2. If you are sending attachments to the Insurer, check off the box next to “Attachments being sent, if any”. If this box is checked, you must use the space to describe the attachment. This tells the adjuster not to adjudicate the form until they have received the documents you are sending.

   • If you’d like to submit an attachment as part of the OCF, you cannot embed it into the OCF. Items like PDF files, Excel files, or Word documents must be faxed or mailed directly to the Insurer.

3. If you’d like to save the OCF as a Draft, you can click “Save”. A yellow bar across the top will indicate that your form has been saved successfully. (View screenshot)

4. If you are ready to submit your OCF, click “Submit”. The successful submission window will appear.

5. A unique HCAI document number is generated. This number can be used to track this form.   Insurance adjusters can also track this form in their system using this document number. (View screenshot)

6. To print the submitted OCF, click the “Print” button. The HCAI document number will be displayed on the printed form.

Create an OCF-18 Template/Draft

If you plan on filling out multiple OCF-18s with similar information, you can save a draft OCF-18 as a template that can be customized in the future. The save as draft feature is also useful if you need to stop in the middle of filling out an OCF and resume at a later time.

To create a draft OCF-18 from scratch:

Please note: If you are currently filling out an OCF-18 but have not yet submitted it, you can use it to create your draft at any time. Skip to step 3 below.

1. To create a draft OCF-18 from scratch, go to the Plans tab and the Work in Progress sub-tab.

2. Create a new OCF-18 by selecting OCF-18 from the drop-down list and clicking “Create new”.

3. In order to save the OCF-18 as a draft, the following fields must be complete (but can be modified after saving):

   • Claim or Policy Number

   • Patient first name

   • Patient last name

4. Click on the “Save” button in the top right or bottom right of the OCF window.

5. A yellow bar will appear on the Form stating, “Document was saved successfully”. You can now exit the OCF.

To use a draft OCF-18:

1. You can access drafts that have been saved by clicking on the Draft sub-tab on the Plans or Invoices main tab. (View screenshot)

2. To open a draft, click on the magnifying glass button to the left of the OCF Type.

3. You may modify any fields as needed and then click “Save” again or submit the OCF. Submitting the OCF will not delete the draft. The draft version will still be available in the Drafts sub-tab for future use.

To delete a draft:

1. Click on the Drafts sub-tab of the Plans or Invoices main tab.

2. Select the checkbox to the left of the draft you wish to delete.

3. Click the “Delete” button at the bottom of the list.

4. Click “Okay” on the pop-up prompt that appears.

Please note: It is best practice to delete any drafts that are older than one year. Drafts older than one year may reflect old versions of forms and may not be able to be submitted.