New HCAI Guidelines for submitting OCF-21

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The Financial Services Commission of Ontario (FSCO) has issued new HCAI Guidelines for submitting OCF-21. According to the guideline, the OCF-21 invoice must indicate the OCF plan number to which it is associated.

Please see the attached document release by HCAI and the HCAI May 2012 Update Release for a detailed description of changes effective July 1 2012.

HCAI System Unavailability

The HCAI system will be unavailable from 5:01 p.m. (EST) June 29th, 2012 and is expected to resume active status at 8:00 a.m. (EST) July 3rd, 2012.

Every integrating Insurer and Health Care Facility must have all of their transactions successfully processed by 4:59 p.m. (EST) June 29th, 2012 if they are to be processed under the HCAI December 2011 Guideline.

Summary of Changes

  1. HCAI key OCF21B_Plan_Document_Number is no longer in use. This key must be blank at all times. HCAI mapping to this key must be removed.
  2. HCAI Key OCF21B_PreviouslyApprovedGoddsAndServices_PlanNumber must be used to submit the HCAI Document Number (plan number). This field will be a mandatory field. Acceptable values are:
    • A valid OCF 18 HCAI document number
    • Keyword "exempt" - comments can be added to the Invoice Comments field on the invoice to add the reason for using this keyword.
  3. The following HCAI Keys must always be blank:
    1. OCF21B_PreviouslyApprovedGoodsAndServices_Type
    2. OCF21B_PreviouslyApprovedGoodsAndServices_PlanDate
    3. OCF21B_PreviouslyApprovedGoodsAndServices_AmountApproved
    4. OCF21B_PreviouslyApprovedGoodsAndServices_PreviouslyBilled
    5. OCF21B_HCAI_Plan_Document_Number
  4. The Header_ClaimNumber must always be blank or same as on the plan.
  5. The Header_PolicyNumber must either be blank or same as on the plan.

Reason Codes

There will be new reason codes which insurers will apply to line items in the Adjuster Response messages. These new reason codes can be found on page #4 in the attached document.

New Validation Error Messages

There will be new validation error messages. A list of the error messages can be found on page #5 in the attached document.

Should you have any questions or concerns, please do not hesitate to contact SmartSimple Support at support@smartsimple.com or 416-591-1668.

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