HCAI- Health Care for Auto Insurance

What is HCAI or Health Care for Auto Insurance?

HCAI is a web-based platform used to automate the transmission of auto insurance Ontario Claim Forms (OCFs) between Health Care Facilities (HCFs) and Auto Insurers in Ontario. HCAI Tracking of plans and invoices has become a central part of the system for Therapists. HCAI is overseen and regulated by the Financial Services Regulatory Authority of Ontario (FSRA). FSRA sets out three types of Health Care Providers: Health Practitioners (Chiropractor, Nurse Practitioner, Dentist, Occupational Therapist, Optometrist, Physician, Physiotherapist, Psychologist, Speech-Language Pathologist); Regulated Health Professionals (Chiropractor, Nurse Practitioner, Dentist, Massage Therapist, Occupational Therapist, Optometrist, Physician, Physiotherapist, Psychologist, Speech-Language Pathologist and Social Worker); and Unregulated Health Professionals (Rehabilitation Therapist). 

MVA Treatment Plans

HCAI has several plan options, depending on which guideline your client falls under. 

OCF-23 Treatment Confirmation Form
The OCF-23 is the form used by a Facility and/or associated Provider to inform an Insurer that treatment for an injured person will commence within the Minor Injury Guideline (MIG). If an Insurer confirms that the Claimant has a valid policy, treatment in the OCF-23 does not require prior Insurer approval.

OCF-18 Treatment and Assessment Plan
Generally, an OCF-18 treatment plan is completed after allocations under the Minor Injury Guideline have been exhausted or the injured person has been deemed to be outside of the MIG. The OCF–18 describes the cause and nature of injuries that are a direct result of the motor vehicle accident. It outlines assessments or examinations that a Health Care Facility or associated Provider feels are required for ongoing management of the Claimant’s recovery.

Form 1 or Assessment Of Attendant Care Needs

Form 1 is a mandatory form used to report the need for attendant care as the result of an automobile accident. It identifies the need for routine personal care, basic supervisory functions, and complex health/care and hygiene functions. Form 1 must be completed by an Occupational Therapist or Registered Nurse who assesses the needs of the applicant. Facilities that are enrolled with HCAI will be able to submit Form 1 to insurers electronically through HCAI using either a Case Management System (CMS) that is integrated with HCAI or the HCAI web channel. Use Skedulex Case Management System to create and submit your Form 1 and save time.

MVA Billing and HCAI Billing

HCAI has two invoices.

OCF-21B – Auto Insurance Standard Invoice
The OCF-21B is used to bill automobile Insurers for the medical and rehabilitation goods and services, assessments and examinations submitted under the OCF-18 Treatment Plan. 

OCF-21C – Auto Insurance Standard Invoice
The OCF-21C is used to bill automobile Insurers for the medical and rehabilitation goods and services, and examinations delivered in the Minor Injury Guideline (for accidents on or after Sept 1, 2010).

HCAI billing is a complication process. Clinics should consider using HCAI billing software, such as Skedulex Case Management Software, to manage their clients and billings. Skedulex is fully integrated with HCAI billing, tracks plan balances and allow therapists to post their billing charges to a plan, easily and efficiently. 

Who is HCAI?

HCAI, a not-for-profit organization, is an initiative of Ontario auto insurers. HCAI has been developed in consultation with the Financial Services Regulatory Authority of Ontario (FSRA), Health Care Provider Associations and other stakeholders in the auto insurance system. FSRA mandates that all invoices and payments for health care services to injured persons (claimants) rendered by HCFs insurance companies be processed and paid through the HCAI system.

How to use HCAI?

HCAI provides two ways for HCFs to use its system.

HCAI Website
Log-in directly to the HCAI website. A direct log-in is the least efficient system, used mostly by companies that are still paper-based. All data entries to the website must be done from scratch; thus clinic may enter the same information 4-5 times for each client. The website approach is inefficient and has many disadvantages, as clinics must find another way to manage their clients’ information, schedules, clinical and progress notes, etc. Clinics using the website to do their HCAI billing have to keep a separate tracking system.

Skedulex Case Management Software
Use of a Case Management Software CMS (or Practice Management Software PMS) that is integrated with HCAI, such as Skedulex Case Management Software. This integration allows the CMS to connect directly with HCAI, send and receive requests and approvals or plans and invoices. HCAI refers to these forms as OCFs. Using an integrated CMS is efficient as there are no entries made in HCAI. The CMS is used to manage all clients’ information, schedules, clinical and progress notes, HCAI plans and invoices. The CMS submits plans and invoices directly to HCAI.

Skedulex and HCAI

Skedulex is an innovative Web-based software for managing the entire facility, including HCAI. Use Skedulex to prepare and submit your Form 1 and save time. Skedulex improves your bottom line while allowing you to work from anywhere and at any time. Skedulex is easy to learn and use. Submitting your OCF plans and invoices has never been easier. Skedulex has templates, drafts to make your submissions as easy as possible. Skedulex, in addition to submitting directly to HCAI, tracks plan balances, on a line-by-line basis. Skedulex checks your invoice submissions against your plan balances preventing over billing issues with the insurer.

Skedulex is commonly used in Occupational Therapy, Speech Therapy, Counselling, Psychology, Rehab, Physical Therapy, Social Work, Psychotherapy, Home Care, Med-Legal and Med-Legal Assessments.