Compliance
F S CO SERV ICE PR OV IDER L I CE NSI NG
S
ignificant changes in the way auto insurance is regulated were made in 2014.
Most relevant to chiropractors, the Financial Services Commission of
Ontario (FSCO) initiated the optional licensing of service providers who care
for patients who have been involved in motor vehicle accidents (MVAs). This
article gives a brief overview of how this change will affect your practice.
On December 1, 2014, it became
mandatory for clinics to have a current
valid Service Provider Licence in order to
receive direct payment from auto insurers
for listed expenses invoiced through the
Health Claims for Auto Insurance (HCAI)
system.
FSCO has issued approximately 3,100
Service Provider Licences and there are an
additional 300+ under review. An analysis
of HCAI determined that this accounts for
93% of the market for health care resulting
from MVAs.
Service Provider Licences only reflect
that a health care facility is licensed
to receive payment directly from an
insurer for care related to an MVA. This
licence is in no way a commentary on a
chiropractor’s competency or whether their
care meets the requirements of the CCO’s
Standards of Practice.
What Hasn’t Changed
Many aspects of auto insurance remain the
same. All chiropractors retain the right to
treat auto insurance patients, whether they
have a Service Provider Licence or not.
HCAI processes remain the same. All
practitioners continue to complete and
submit Treatment and Assessment Plans
16
WINTER 2015
(OCF-18), Treatment Confirmation Forms
for the Minor Injury Guideline (OCF23), and the Auto Insurance Standard
Invoice (OCF-21) through HCAI. Insurers
continue to record their adjudication
decisions in HCAI for all invoice
submissions from licensed and unlicensed
service providers.
The standard fees for auto insurance
services continue to apply to all health care
providers.
What Has Changed
The process of reimbursement now
depends on whether or not a business has
a Service Provider Licence. While licensed
businesses may continue to receive direct
payment from auto insurers, insurers
are prohibited from paying unlicensed
businesses directly for “listed expenses”
invoiced through HCAI.
Licensed businesses now have several
business standards to comply with in order
to keep their licences.
Basic Requirements
information,
• Ensure business locations are registered,
enrolled and in good standing with
HCAI,
• Ensure no invoices or documents submitted to HCAI are inaccurate, false or
misleading,
• Conduct periodic reviews of documents
submitted to insurers to ensure compliance with legislation and applicable
guidelines and reconciliation of billings,
• Retain records related to goods and
services provided for at least six years,
• Report important changes in the service
provider’s business license, such as
a change in contact information, principal representative or partner within five
business days, and
• File an Annual Information Return
(AIR) each year. The AIR collects
information about the service provider’s
business systems, practices and controls
in connection with billing for listed
expenses in the previous calendar year.
Licensed businesses are required to:
• Respond to insurer requests within
10 business days for certain types of
Policies and Procedures
Licensed businesses \