HCAIHCAI

The Assessment of Attendant Care Needs Form (Mandatory Form 1) must be submitted through the HCAI system, starting October 1, 2018. The current paper submission will give way to an electronic submission, taking HCAI one step further along the compliance path for PHI Data transfer. The objectives of the change were twofold:

  • To make it easier for healthcare providers to submit and track the document.
  • To improve insurers’ ability to monitor and adjudicate claims.
  • To improve PHI transmission compliance in accordance with PHIPA and HIPA.

All facilities enrolled with HCAI must submit Form 1 to insurers electronically, using either a practice management system (PMS) that is integrated with HCAI, or the HCAI web channel. Invoices for attendant care services will continue to be submitted and processed outside of the HCAI system, although there have been ongoing discussions on brining this task to the HCAO system.

 

The Financial Services Commission of Ontario (FSCO), the government agency that regulates the auto insurance industry, recently issued an advisory to all automobile insurance companies and healthcare providers. The advisory said that effective October 1, 2018, all facilities must submit the Assessment of Attendant Care Needs Form (Form 1) through the Health Claims for Auto Insurance (HCAI) system. Furthermore, all insurers must communicate their approval or rejection of the Form 1 through HCAI.

Currently most Form 1 are being communicated to Insurers mostly via Facsimile. The original Form 1 was amended in 2016 to facilitate its automation into the HCAI system.  On October 1, 2016, a revised Form 1 was released and the voluntary pilot project in the HCAI system was launched. Prior to the pilot project, the completed Form 1 was submitted in paper format to auto insurance companies. In the interim period running up to October 1, 2018, submitting Form 1 electronically remains optional.

Automation of Form 1 into the HCAI system on a pilot basis allowed healthcare providers the option to submit it electronically rather than by fax or mail. The objective of the change and pilot was to make it easier for healthcare providers to submit and track the document. In addition, insurers would be better able to monitor and adjudicate claims. Existing application and adjudication processes remained unchanged.

The pilot tested the success of submitting Form 1 electronically both through the HCAI portal and through third-party software systems. It demonstrated that benefit amounts could be proposed, approved and tracked with ease.

 

What is the Assessment of Attendant Care Needs Form (Form 1?)

Form 1 is a Superintendent-approved form required when an injured claimant applies for attendant care benefits in accordance with the Statutory Accident Benefits Schedule (SABS) section 42(1).

An occupational therapist or registered nurse must sign Form 1. It sets out the claimant’s specific attendant care needs and the associated monthly cost following an accident. The completed Form 1 is submitted to an auto insurance company for approval.

 

What is HCAI?

HCAI, a non-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, according to HCAI. FSCO requires that all invoices for health care services to injured persons (claimants) rendered by HCFs insurance companies be processed and paid through the HCAI system.

The Health Claims for Auto Insurance (HCAI) platform is a web-based platform used to automate the transmission of auto insurance Ontario Claim Forms (OCFs) between health care facilities (HCFs) and insurers in Ontario. Facilities and regulated health professionals must enroll with HCAI for the electronic submission of Form 1. Additional information on the HCAI enrolment process can be found at www.hcaiinfo.ca

 

What is Skedulex?

Skedulex Case Management software is fully integrated with the new Form 1 or Assessment of Attendant Care Needs Form on HCAI. Skedulex users may submit their Form 1s starting with the directly from Skedulex software.

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