References

HCAI – Health Care Facility/Provider information

http://hcaiinfo.ca/Health_Care_Facility_Provider/index.asp

FSCO – Auto Insurance Claims Forms (OCF Forms)

http://www.fsco.gov.on.ca/english/forms/autoforms/claims/default.asp


HCAI PMS Setup


In order for W5 to communicate with HCAI, PMS integration must be setup on the HCAI website in Facility Management.

  • First log into hcai.ca

  • Click on the “Manage” tab

  • Click on the “Facility Management” tab

  • Locate the “HCAI Submission Method” section near the bottom

  • Set the “Practice Management System (PMS) Integration” value to “Yes”

  • In the “PMS Vendor” field, enter “Burkitt Computer Corporation”.

  • In the “PMS User Name” field, enter a user ID that would be unique to BCCORP and your

    company. For instance, if your company name is ABC Company, enter something like “bccorpabc”.

o Make a note of the User Id assigned.

  • Click the “SAVE” button at the bottom.

  • Then go back down to the “HCAI Submission Method” section and click the “RESET PASSWORD

    FOR PMS USER” button.

o Make a note of the password that HCAI generates.

  • Provide BCCORP with the PMS User ID and Password.

  • BCCORP must setup the background process that will communicate with HCAI using these

    credentials.

Custom Reports


There are multiple Custom Reports used in conjunction with HCAI. They can be found under Custom Reports > HCAI. Each of these reports are referred to within the contents of this document in the context in which they should be used.

     

    • HCAI – Insurer List – this report lists all of the Insurers that are registered with HCAI. If the Insurer is not on this list, then they do not accept submissions through HCAI. This report is used to lookup the Insurer IDs to put on the Client record (see below).
    • HCAI – Provider List – this report lists all of the Providers that have been entered within the HCAI web site under the Facility Management form. It also indicates to which Provider in W5 each point to.

    • HCAI – Invoice Review – this report lists all OCF-21B invoices. It also indicates the status of the invoices. The grid filters and column sorting can be used to isolate which invoices are in error, submitted successfully, or approved.


    Clients / Insurers

    For each Client for which you want to submit OCF-21 invoices, you must set them up as follows. On the Client form (located at Admin tab > Maintenance > Client Coding > Client):


    • On the Client Profile > Settings tab, set the flag labeled “This client requires HCAI Submissions”

    • Fill in the Company ID and Branch ID (using the information found in the HCAI - Insurers List

      Custom report)

    • Both of these fields are required for submitting to HCAI. Some Insurers have multiple branches. You must choose one of the branches.
    • If you need to bill a second branch, then you must create a second Client within W5 and enter the Insurer ID/Branch ID of the second branch.
    • Within the HCAI – Insurer List report, the Insurer ID is what you need to use in theCompany ID field on the Client record.
    • You can optionally fill in the Branch Name field. This field does NOT get submitted to HCAI, but does show up on the printed OCF-21 reports.


    Providers


    For each Provider that will be used as a Service Provider on an OCF-21, you must ensure they are connected to HCAI properly via the HCAI Registry Id. This is how.
    On the Provider form:

    • Enter the Provider’s Registry ID in the “Facility Registry IDs” grid located at the bottom right (using the information found in the HCAI - Provider List Custom report)

      o HCAI will assign a unique Registry ID to each Facility that is setup within W5. Each of these must be entered within this grid.

    • Additionally, for each Provider, the Primary Profession must be specified and it must match what was entered within the HCAI website. This can be done on the Credentials tab within Provider Maintenance.


    Forcing an Insurer and Provider Update


    W5 contacts HCAI every 30 minutes to discover if any new Providers or Insurers have been added. You can however force W5 to check for updates immediately. To do so, you can run the HCAI – Force an Insurer/Provider Update Custom report.


    Case Information


    When submitting to HCAI, they require that the Injuries and Sequelae section be filled in on the OCF-21. W5 will fill this in automatically for you given that you have specified a Nature of Injury code on the Case tab on the Case. For more information, refer to Appendix A: ICD-10-CA (Injury and Sequelae) Partial Pick List on the HCAI Reference website listed at the top of this document.


    Charges


    When entering charges, there are various additional pieces of information that are required.


    Codes

    • You must enter a valid CCI, GAP, or PAF code on the Charge form within the External Code field. This field maps to the Code column listed on the OCF-21B in the Goods and Services section. For more information, refer to Appendix B: CCI (Intervention/treatment) Partial Pick List, Appendix C: GAP, and Appendix D: PAF on the HCAI Reference website listed at the top of this document.

    • In addition to the CCI code, healthcare services can be further specified with Attribute Codes. These codes are used to indicate how the service was delivered or the number of views in an Xray study. You may optionally enter an Attribute value in the External Sub Code field. This field maps to the Attribute column list on the OCF-21B in the Goods and Services section. For more information, refer to Appendix B: CCI (Intervention/treatment) Partial Pick List on the HCAI Reference website listed at the top of this document.

    • You must enter a valid Measure code in the External Measure field. This field maps to the Measure column listed on the OCF-21B in the Goods and Services section. Valid values for this field are: Gd, Hr, Km, Pg, Pr, Sn. These codes stand for Good, Hour, Kilometre, Page, Procedure, and Session, respectively. HCAI validates these codes as certain Measures can only be used under certain CCI/GAP codes. For more information, refer to Appendix F: Unit Measures on the HCAI Reference website listed at the top of this document.

    Service Provider

    You must also enter a Service Provider that has previously been registered on the HCAI website and has been properly attached to HCAI as per the Providers section in this document.


    Issuing an Invoice


    The “This client requires HCAI Submissions” flag on the Client record tells W5 whether or not the OCF- 21B is going to be able to be sent to HCAI or whether it is a print-only OCF-21B.

    On the Case, click on the “Action” button at the bottom right and select “OCF-21 Billing Wizard”.

    After issuing the OCF-21B Invoice, the contents of all of the tabs of the OCF-21B form should be reviewed. This includes Part 1 – Applicant Info, Part 2 – Ins. Co. Info, Part 3 – Invoice Info, Part 4 – Payee Info, Goods and Services, Other Insurance, Amounts, and Additional Info. After having reviewed the contents of all of these tabs, and verifying that all of the data is accurate, you may submit the invoice to HCAI.

    Submitting the invoice is done on the Form Status tab. Click on the “Submit to HCAI” button to queue the invoice to be submitted. After doing so, W5 will take a few moments, after which it will submit the Invoice behind-the-scenes. It is advisable to remain on the OCF-21B form until you have either confirmed success or failure. Press the “Refresh” button on the OCF-21B form until you either see an error or a success message show up in the “History” section of the Form Status tab.

    The History section is a full audit of the life of the OCF-21B form. It contains all changes made as well as any actions taken against the OCF-21B.


    What to do when a Submission Error is encountered


    When you encounter a submission error, you must try to correct the error to the best of your ability. After doing do so you must “Regenerate Invoice Data”. “Regenerate Invoice Data” is a button on the Form Status tab that regenerates the OCF-21B invoice information based on the information found on the case and charges. Any changes that you needed to make to correct the submission error will need to be re-fetched back onto the OCF-21B form via the “Regenerate Invoice Data” button. After regenerating the invoice data, you must then resubmit the Invoice once again by pressing the “Submit to HCAI” button.


    What to do when a Submission is successfully processed


    After you submit the invoice and have refreshed the Form, when the form has been successfully submitted you will see at least three records show up in the History grid.

    1. Action Requested HCAI – Request Submit
    a. This indicates that you requested that W5 submit the invoice to HCAI

    2. Status Changed Submitted – Pending Review
    a.
    This indicates that the invoice was submitted successfully to HCAI and they have

    acknowledged this by changing the status to “Submitted” 3. Action Completed HCAI – Request Submit

    a. This indicates that W5 has fully completed the Submit action that you requested.

    Note: there will be additional records showing up in the History grid that show changes to values. In general you can just skip over these when searching for the above records.


    Ongoing monitoring of Invoice Status


    The current Status of the OCF-21B can be seen on the Form Status tab near the top of the form. Also, the current status of all invoices can be reviewed using the HCAI – Invoice Review Custom report. This report lists all invoices and their statuses.


    When the Insurer reviews the submitted OCF-21B invoice, they will either deny the invoice or approve it. Behind-the-scenes, W5 connects to HCAI every 30 minutes to retrieve any status changes for all submitted invoices. As soon as an invoice is either denied or approved, the status of the invoice will be set to Declined, Approved, or Partially Approved based on what the Insurer says.