OCF-21C – Auto Insurance Standard Invoice

Create an Invoice from a Plan

Creating an invoice from a plan has useful benefits, including the following:

• It auto-populates certain fields from the submitted plan, such as the Claim Identifier and Parts 1, 2, and 4

• It auto-populates the plan’s Document Number and links to the plan

• It makes it easier to view the plan’s treatments and approved amounts

• It saves times, and

• It ensures data accuracy

To create an invoice from a plan:

1. Locate and open the submitted plan (OCF23).

2. Click the “Create Invoice” button near the top left of the window, and you will be brought directly into an invoice (OCF-21C).

3. Many of the fields in the OCF-21C will be populated from the submitted plan, including the associated plan’s Document Number.

4. Click on the plan’s Document Number under Part 3: Invoice Details to open and review its contents while completing the OCF-21C.

Please note: If you create an invoice from a plan that had an insurer branch selected, and this branch is no longer accepting new documents, you might receive a pop-up message stating "Either the insurer or the branch is deactivated or not accepting new documents. Please select another branch or insurer".

1. To continue, press 'Ok'

2. In the OCF-21C, navigate to Part 2: Auto Insurer Information

3. Select a new branch or contact the Insurer to find out how to proceed

Claim Identifier and 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. Carefully entering Claim Identifier and Applicant Information is important for matching purposes. View Submitting and Storing forms for more information on matching.  (View screenshot)

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

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-21s must be submitted via HCAI. Insurers and Independent Adjusters cannot receive the OCF-21 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/Patient.

   • 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: Invoice Details

This section identifies the plan that is associated with this invoice and whether or not this is the first and/or last invoice under this plan. (View screenshot)

1. If your Facility uses an internal Invoice numbering system, enter it in the Provider Invoice Number. This field is not mandatory and may be left blank. This number will appear in the HCAI worklist and can help you locate an invoice after it has been submitted.

2. Click “Yes” for First Invoice if your Facility has not previously invoiced the Insurer for the associated Plan.

3. Click “Yes” for Last Invoice if this is the last invoice to be submitted for the associated Plan.

Previously Approved Goods and Services

This section asks, “Is this invoice for goods and services described on an OCF-23 in HCAI?”

If the goods and services being invoiced are included in the associated OCF-23 (Plan), select “Yes” and type in the Plan’s Document Number.

If you do not have the Document Number, select “Yes” and type “exempt” (case sensitive) into the Document Number field.

If you created this Invoice from a Plan, the Document Number will auto-populate.

If your invoice includes goods and services that are not included in an associated Plan, select “No”. This indicates you have selected an exemption from providing a Document Number. FSRA’s HCAI Guideline explains when it is appropriate to request an exemption.

If you are invoicing for services that were proposed on a Plan submitted by a different Facility, enter the document number provided to you by the submitting Facility.

Part 4: Payee Information

1. To comply with FSRA’s service provider license business rules, Part 4 asks, “Is the payee the Health Care Facility?” (View screenshot)

   • If a valid service provider license was held by the Facility on all dates of service as well as the date of OCF submission, “Yes” may be selected.

   • If the Facility does not have a service provider licence, or did not have a service provider licence at the time the services were provided, select “No”. The Insurer may only pay the Claimant directly. The Claimant must provide a paper print-out of the HCAI-submitted OCF to the Insurer prior to the Insurer adjudicating and issuing a payment.

   • Visit the Service Provider Licensing page for more information about SPL.

2. During registration, the Facility will have chosen “Yes” or “No” to the question “Payee Field Editable?”

   • If “No“ was selected, the Make Cheque Payable To field cannot be edited.

   • If “Yes” was selected, the field next to Make Cheque Payable To must be completed.

Part 5: Injury and Sequelae Information

In this section, list the injuries and sequelae that are a direct result of the automobile accident.

Injuries or problems are coded using the standard descriptions from the International Classification of Disease, 10th version, 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.

1. Enter the Code into the text field and use the “Confirm Codes” button to ensure the codes entered are correct and populate the Description column. If you enter an invalid code, an error message will appear in HCAI.

2. You can also use the code search utility by clicking the “...” button. (View screenshot)

3. The Injury Code Lookup window opens.

   • Use the drop-down menus to select the Series and Category and then click the “Search” button.

   • Click the “Add” button next to the applicable code to add it to the invoice.

Questions about coding

Patients treated in the Minor Injury Guideline (MIG) generally have an injury consistent with the Guideline.

If you have questions about which injury code(s) to use, contact your health professional association. HCAI Support do not have medical training and cannot help you determine which code to use.

Adding additional lines for injury/sequelae codes

If more space is required for additional injuries or problem codes, extra lines may be added by clicking button the ‘+’ button. (View screenshot)

Part 6: Goods and Services Rendered

In this section, provide details of specific interventions that were delivered. The cost of each intervention is NOT entered in Part 6. (View screenshot)

This section uses CCI (Canadian Classification of Interventions) codes or GAP (Goods, Administration, and Other) including MIG codes, as well as Unit Measures and Provider Type codes.

• GAP Codes (PDF)

• Provider Type Codes (PDF)

• Unit Measures (PDF)

Visit the Coding page or view the Intervention Coding Basics video for more information.

Date Services Rendered

1. All dates that the Applicant attended for treatment should be listed using the Calendar tool.

Code

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. (View screenshot) Select either “CCI” or “GAP”.

   • 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.

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

To insert Provider(s) for multiple line items

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

2. Check the boxes 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).

Use the correct unit measure that corresponds to the service described.

• Most treatment interventions should use the PR (procedure) or HR (hour) measure.

• All “Goods” must use the GD (goods) measure.

• Disbursements, such as parking, may be conveyed using “Other” (AXXOT) goods using the GD measure.

• Goods and Supplies not listed in HCAI’s GAP codes can be entered using the “Other” Goods and Supplies Code (GXX99) and providing a description.

• Mileage expense must be conveyed using the KM (kilometer) measure.

• Do not use the GD unit measure for documentation review or preparation. The unit measure HR is more appropriate.

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 “Confirm Codes” button, then click the “GO” button.

Reimbursable Fees within the Minor Injury Guideline

In this section, the MIG Block Billing Fees are entered. (View screenshot)

This section uses MIG Block Billing Codes, which can be found here:

• MIG Codes required to complete block billing of MIG services (PDF)

First Date of Service

1. Select the first date that service was provided for each treatment, using the calendar tool or by entering the date as YYYY/MM/DD. For block fees, this is the date the block of services was initiated.

Code (MIG Block Billing Code)

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

2. The “Search Goods and Services Codes” window opens. (View screenshot)

   • The only “Section” available will be the Minor Injury Guideline. Select MIG.

   • The Intervention drop-down menu populates. Select an Intervention in order for the Group menu to populate.

   • The only Group option is the Minor Injury Guideline.

   • Click the “Search” button.

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

Please note: CCI codes are not available under Reimbursable Fees within the Minor Injury Guideline of the OCF-21C. To learn which services are pre-approved and the maximum fees payable, review the Minor Injury Guideline published by the Financial Services Commission of Ontario.

Provider reference

1. To select the Provider Reference, click on the “...” button to open the “Select Providers” window. (View screenshot)

2. Use the drop-down tool to select the name of the Provider and, if they have more than one profession listed in HCAI, the applicable Provider Profession.

3. Click on the “Submit” button.

At least one Provider must be listed for each treatment block. If more than one Health Care Provider delivered care within a block, list up to three Providers who were most responsible for each treatment block listed on the Invoice. The Providers will be displayed in the order they were selected.

To insert 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 (View screenshot).

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

Maximum Fee

This column displays the maximum fee for Minor Injury Guideline items. This column will appear blank until a line item is entered.

Cost

1. Enter the cost for each block of treatment.

Add more Items

1. To add lines for additional Good and Services, next to “Add more items” select the number of items/lines you want to add from the dropdown and click on the ‘GO’ button.

Calculate

1. Click the “Calculate” button to see the “Minor Injury Guideline Fee Totals.”

   • If the Estimated Fee of a line item exceeds the Maximum Fee, a symbol will appear beside the item and a message will appear at the top of the section advising that the proposed amount exceeds the maximum allowable limit under the FSRA Minor Injury Guideline.

   • You are still able to submit the OCF-21C if the message displays.

   • The Insurer will see the same message.

Other Insurance (for goods and services on this invoice)

In this section, enter the total amounts received or estimated to be payable to you on these invoices from other insurance sources. Do not use a negative (-) sign for these amounts. (View screenshot)

1. Enter amounts that you have or will receive from other insurance sources.

   • Categorize amounts by chiropractic, physiotherapy, massage therapy and other. When the category “Other” is used, specify the type of services covered in the text field (e.g., dental, psychological, optometric).

   • Values entered into this section will be subtracted from the sub-total to determine the amount owed by the automobile insurer.

2. Answer the question “Do you want to claim any amount not reimbursed by other insurance sources?” using the “Yes” or “No” radio buttons.

   • If you select “Yes”, a second section appears where you can enter amounts refused from other insurance sources that you want to claim as a part of this invoice.

   • Categorize amounts by chiropractic, physiotherapy, massage therapy and other.

   • When the category “Other” is used, specify the type of services covered in the text field (e.g., dental, psychological, optometric).

   • Values entered into this section will be added to the sub-total to determine the amount owed by the automobile insurer.

3. Click the “Calculate” button to populate the Total fields.

Totalling

The Totalling section compares the amount proposed on the treatment plan to the actual amount invoiced. It is possible to invoice for amounts greater than or less than those proposed on a plan, but the Insurer may request an explanation.

The Totalling section includes the following fields: (View screenshot)

Sub-total: Sum of the cost of all services documented in the “Reimbursable Fees within the Minor Injury Guideline” section.

Minus MOH: Sum of all Ministry of Health and Long-Term Care amounts.

• This amount is taken from the Total for the MOH line.

• Amounts paid to you or expected to be paid to you are subtracted from the amount billed to the Auto Insurer.

• Amounts that you previously stated were available but were unable to collect are added to the Auto Insurer’s invoice.

Minus Other Insurer (1 + 2): Sum of all amounts received or payable to you from other Insurers.

• This amount is taken from the Total for the Insurer 1 and Insurer 2 line.

• Amounts paid to you, or expected to be paid to you, are subtracted from the amount billed to the Auto Insurer.

• Amounts that you previously stated were available but were unable to collect are added to the Auto Insurer’s invoice.

Tax (if applicable): Enter the sum of the tax for any goods or services subject to the Harmonized Goods and Services (13%) Tax or other applicable tax.

Prior Balance*: Enter Prior Balance (the “Auto Insurer Total” from your last invoice).

Payments Received from Auto Insurer: Any payments received can be entered here.

Overdue Amount*: Subtract payments received since your last invoice to calculate the overdue amount.

Interest*: Enter the interest owing as a result of the overdue amount.

Auto Insurer Total: The sum of all amounts in this section. To view the total, click the “Calculate” button.

*Prior Balance, Overdue Amount and Interest are used as the basis for interest charges that have accumulated and can be calculated into the Total for this invoice. Only the interest charges will be calculated into the total payable by the auto Insurer.

Calculating Prior Balance, Overdue Amounts and Interest Charges

If your facility has submitted an invoice prior to the current invoice, but it has not been fully paid, you may document the outstanding amount and associated interest on this invoice. To do so:

1. Enter the Prior Balance – which is the amount of the previous invoice.

2. Enter the Payment Received from Auto Insurer from the previous invoice.

3. Enter the Overdue Amount* from the previous invoice.

4. Enter the Interest as calculated on the overdue amount.

*The overdue amount will not be added to the Auto Insurer Total on this new invoice. Only the interest amount will be added to this invoice. The previous invoice is still effective and amounts from prior invoices should not be added to new invoices.

Tax

1. Taxes are included in the MIG block billing fees. If applicable, enter additional tax costs in the tax field.

Additional Information

Space is available for comments if there is a need to provide the Insurer additional explanations/clarifications. There is a limit of 500 characters in the comments field. If more space is needed, use Tab 5. (View screenshot)

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 the box is checked, you must then 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. 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)

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

Process Overpayments or Credit

Occasionally, a Facility may wish to reimburse an Insurer for overpayment or to issue a credit. You may create a single invoice for the overpayment/credit or process the overpayment/credit with other goods and services on an invoice.

1. If you are processing the overpayment/credit with other goods and services, skip Step 2 below and begin at Step 3.

2. If you are creating a single invoice only for the overpayment/credit, create the OCF-21C either from a plan or from scratch. When you reach the Reimbursable Goods and Services section, enter one line item. The amount entered under “Cost” for the line item should be 0.00. This is because the invoice needs at least one line item. (View screenshot)

3. Go to “Other Insurance (for goods and services on this invoice” in Tab 4 and enter the amount for repayment in the Insurer 1 row, in the column labeled **Other Service. (View screenshot)

   • Do not enter a negative (-) sign in front of this amount.

4. In the box labeled “**Other Service Type Specified”, write in the reason for the credit. You may, for example, choose to write “Overpayment by insurer” or “Overpayment/Credit of [xxx]” in this box.

5. Go to the Totalling section.

6. Click the “Calculate” button. The credit amount will be displayed in the “Proposed” column within the “Minor Other Insurer (1+2)” field.

7. Submit the form.

Collect Interest Owed on Outstanding Invoices

The SABS S.51 authorizes payment of interest on overdue amounts, for plans that have been approved by insurers and invoiced more than 30 days ago. This can be done via HCAI.

To charge interest on outstanding amounts owed to your Facility, the process depends on whether the patient is still receiving services at your clinic or not.

If the claimant is still attending treatment

When preparing the next invoice for a patient still attending treatment, we recommend adding the interest owing to the next invoice, in the Totalling section.
The Totalling section allows you to outline the Prior Balance (from the last invoice), the Payment Received by Auto Insurer, the Overdue Amount, and the Interest. When you press the “Calculate” button, only the interest charge will be added to the total amount proposed to be payable by the Insurer on this new invoice (View screenshot).

If the claimant is discharged

If you have discharged the claimant and no further invoices are to be submitted, you can prepare a new invoice only for the interest amount as follows: (View screenshot)

1. Create an invoice from the plan on which interest is owing. This way, the interest invoice will be linked to the plan for which payment is outstanding.

2. Enter only one item in Tab 4 under Reimbursable Goods and Services. This is because HCAI requires at least one line item. The cost of the line item should be 0.00.

3. In the Totalling section, enter the information about the prior balance, outstanding amount, and interest charges. Click “Calculate” and only interest will be added.

4. In the Additional Information or Additional Comments section, enter a note explaining that this invoice is to charge interest on the outstanding balance for this treatment plan.

5. Press the “save” button to save a draft of this invoice for future use, if you wish.

6. Submit the form.

The Insurer will now have two distinct invoices for the outstanding plan: the one that was submitted originally, and the one charging interest.

Please note: To collect on outstanding invoiced amounts (rather than interest), you may not submit duplicate invoices. This should instead be done by means of a “statement”. The statement is not an OCF and should be sent by fax or mail, not submitted through HCAI.