HCAI- Health Care for Auto Insurance

What is HCAI?

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 have become a central part of the system for Therapists.

MVA Treatment Plans

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 injured person 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 plan is completed after allocations under the Minor Injury Guideline has 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 submit your Form 1 and save time.

MVA Billing and HCAI Billing

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

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 an HCAI billing software, such as Skedulex Practice Management Software, to manage their clients and billings. Skedulex is fully integration with HCAI billing, tracks plan balances and allows 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 Commission of Ontario (FSCO), health care provider associations and other stakeholders in the auto insurance system. FSCO 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 provide 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 seperate 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 sends these directly to HCAI while monitoring plan balances and other billing activities.

Skedulex and HCAI

Skedulex is an innovative Web-based software for managing 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 anytime. 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 checks your invoice submissions against your plan balances preventing over billing issues with the insurer.

Here is a comparison of time entries: HCAI Billing made Easy

Selected Work Areas (Monthly) HCAI Web system and no PMS PMS Solution (single entry)
Monthly Savings 33.9 Hrs
100 clients (each entry takes 60 seconds) 8.3 Hrs 1.7 Hrs.
HCAI: 25 plans and 100 invoices 29 Hrs 20 Hrs
HCAI Tracking 16 Hrs 5 Hrs
QuickBooks 8.3 Hrs 1.0 Hr
Total Hours 61.6 Hrs 27.7 Hrs
HCAI applies to Ontario only

Monthly savings = 33.9*$20/hour = $678.00

The above assumptions suggest that in 4 selected areas of work, implementing Skedulex Solution could save your company approximately 34 hours or $678.00 ($20/hr) each month. Additionally, there would be savings in areas of document storage, clinical notes, scheduling, etc. Could these savings justify the investment in Skedulex Solution?

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