Service Provider Licensing
Learn about FSRA's Service Provider Licensing and how it impacts use of HCAI.
What is Service Provider Licensing?
The Ontario Government determined that a licensing and regulation regime for the business practices of health clinics (service providers) treating auto insurance claimants is appropriate and necessary. Service Provider Licensing (SPL) is implemented and overseen by the Financial Services Regulatory Authority of Ontario (FSRA)*.
*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
Learn more at FSRA’s Health Care Service Providers page.
Explore FSRA’s Public Registry of Licensed Service Providers
How does Service Provider Licensing relate to HCAI?
Per FSRA’s HCAI Guideline, to receive direct payment for submitted invoices, facilities must have a valid FSRA Service Provider Licence both at the time the treatment or service is performed and when the invoice is submitted. Without a Service Provider License, the Insurer must pay the claimant.
Can facilities submit invoices in HCAI without a Service Provider License?
Yes. Per the HCAI Guideline, unlicensed service providers must still complete the OCF-21 and submit it to the insurer in HCAI, even though they will seek direct payment from the claimant.
On invoices in HCAI, Part 4: Payee Information asks “Is the payee the health care facility?” A Facility without a service provider license, or a facility who provided their services before being licensed, must select “No”. The Insurer may only pay the Claimant. The Claimant must additionally provide a paper print-out of the HCAI-submitted OCF to the Insurer so that the insurer can reconcile the printed copy of the OCF-21 with the one submitted in HCAI.
The HCAI Guideline also states that OCF-21 submissions from unlicensed service providers are not deemed to have been received by the insurer until the insurer receives a paper copy of the OC-21 from the claimant. Once the insurer receives the paper copy, they can enter the receipt date into HCAI.
Please review the HCAI Guideline for complete details about submission of the OCF-21 by unlicensed service providers.
Where can I view a facility’s Service Provider License status?
FSRA’s Public Registry of Licensed Service Providers is the most up-to-date authority regarding current license status. In HCAI, Service Provider Licensing information at the time of submission can be found in the following places:
On the OCF-18 in Tab 2 under Part 4: Signature of Health Practitoiner
On the OCF-23 in Tab 2 under Part 4: Signature of Initiating Health Practitioner
On the Form 1 in Tab 2 under Signature of Assessor
On the OCF-21B and OCF-21C in Tab 1 under Part 4: Payee Information
