OCF-21C: Creating Invoice from Scratch
Contents
1. eee 18 PRIOR BALANCE OVERDUE AMOUNTS AND INTEREST CHARGES 18 Mie s 19 Ell c Re 19 ADDITIONAL COMMENTS amp ATTACHMENTS du IE 19 HOW DO KNOW MY FORM HAS BEEN SUBMITTED 19 WHAT IF MY FORM WAS NOT SUCCESSFULLY SUBMITTED 20 When Do Use an OCF 21C An OCF 21C is used when invoicing for goods and services delivered in the Minor Injury Guideline for accidents on or after Sept 1 2010 or the Pre Approved Framework for accidents prior to Sept 1 2010 For all other invoicing use the OCF 21B What Is Included in This Manual The manual provides detailed instructions for the completion of an OCF 21C using the HCAI Web application Where can get more information This manual will be updated from time to time The latest updates to the manual can be downloaded from the www hcaiinfo ca Contact your health professional association for any questions relating to coding of injuries interventions health care services and guidelines as they relate to your specific practice Examples of completed sections of the forms The examples and fees used throughout the manual are entirely fictitious They are designed to assi2. much ad vi ind an rim dmt ton dud 7 PART 1 APPLICANT INFORMATION 8 PART 2 AUTO INSURER INFORMATION sceccececcececcccececceccececaucucuccecucaececuesecsucesseaecseuuecuuuecscauseceeaecass 8 t 9 PARTO INVOICE DETAILS fft mmm 9 PART 4 PAYEE INFORMATION AND CONFLICT OF INTEREST DECLARATION csceccececcececcececcececeececeeees 9 A 10 PART 5 INJURY AND SEQUELAE CODES ccccceccececcececcececcececeececuecuccuecseeuecueaecueausseecscacaucaeaecauaesass 10 PART 6 GOODS AND SERVICES RENDERED sceccececcececcececcececcccucccceccecececuceecueaecseaucecacaucauaeceeaecass 11 TAB a are 13 PART 7 REIMBURSABLE BLOCK FEES WITHIN THE MIG GUIDELINE 2cceccecceceececceccececcecceceececees 13 PART 8 OTHER REIMBURSABLE SERVICES REQUIRING INSURER APPROVAL 14 PART 9 OTHER INSURANCE GOODS AND SERVICES SERVICES CHARGED TO OTHER SOURCES 16 17 e
3. 0 Health Claims for Auto Insurance OCF 21C CREATE A MIG INVOICE FROM SCRATCH MANUAL FOR WEB USERS July 2012 TABLE OF CONTENTS WHEN DO I USE AN 21 4 WHAT IS INCLUDED IN THIS 12 4 WHERE CAN GET MORE INFORMATION 2 cecceceececcecceceeceeceececeeceecueaecaeceeceeaecueceeaesaeceesusaeseeaeetseeaeeas 4 EXAMPLES OF COMPLETED SECTIONS OF THE FORMS 1 hehe ense ne re insere eere renes 4 OCF 21C CREATE INVOICE FROM SCRATCH 5 LL IE LI E E 5 WHO COMPLETES THIS FORM TO PREPARE IT FOR SUBMISSION TO THE 0 5 WHAT IS THE INSURER S ROLE 25 Cu S pad 5 mcm A 5 THERE IS NO FEE PAYABLE FOR COMPLETION OF THE STANDARD INVOICE 5 COMPLETION OF OCF 21C IN 2 2 2 6 6 DE 2 y e 7 CLAIM IDENTIFIERS SPEED UP CLAIMS 7
4. Figure 10 MIG block billing Part 7 Reimbursable Fees within the Minor Injury Guideline or Pre approved Framework Guideline to which this invoice applies Minor Injury Code Description E Initial visit 1 Session Block 1 weeks 1 to 4 BJ Block 2 weeks 5 to 8 BI Supplementary goods and services ae Add more Items 5 Items Use this button with the checkboxes on the left CONFIRM CODES Cost a Estimated Mi or Sub total 1 610 00 CALCULATE When i are satisfied that you have included the blocks you wish to charge for click The system will complete the math for you Part 8 Other Reimbursable Services Requiring Insurer Approval Only applies to accident dates prior to Sept 1 2010 Part 8 should only be completed if the Claimant s date of accident was prior to Sept 1 2010 This section should be completed only if the Insurer approved services in Part 11 of the OCF 23 The services that may be billed in this section are limited to those specified in the PAF Guideline see Table 1 below in Appendix B Additional PAF Interventions The codes for these are all GAP codes The maximum fees payable by Insurers for pre approved services are listed in the PAF Guideline Refer to the PAF Guideline that is published by the Financial Services Commission of Ontario and available on the FSCO website www fsco gov on ca 14 Table 1 Other PAF Services Requiring Insurer App
5. Applicant Information The Applicant patient or substitute decision maker should provide this information to the clinic staff Figure 3 Applicant Information Part 1 Applicant Information Please provide all information requested Values marked with an asterisk are mandatory fields required for submission Collection use and disclosure of this information is subject to all applicable privacy legislation Date of Birth 19560612 wr Gender 2 male O Female Last Name Smith First Name John Middle Name Address 1 1123 Elm St Address 2 City Toronto Province State ON Ontario w Postal ZIP Code M1M 1M1 Phone Part 2 Auto Insurer Information The Applicant patient or substitute decision maker should provide information The last name of the Policy Holder is mandatory Independent Adjusting Companies and Adjusters Independent adjusting companies may be hired by Insurers but the HCAI application does not list independent adjusting companies To direct Claim forms appropriately the Facility should determine typically by asking the Applicant or the independent Adjuster the name of the licensed Insurer that insures the Applicant Insurers that use independent Adjusters IAs are able to give IAs access to so they can view and adjudicate the Claimant OCFs for which they have been authorized Policy Holder Detail
6. In Tab 4 near the bottom of the HCAI page there is space that permits comments if there is a need to provide the Insurer additional explanations clarifications Only 500 characters are allowed here If more space is needed use Tab 5 Figure 14 Additional information Additional Information Make cheque payable to Acme Rehab Other Information CANCEL e 1 PRINT SAVE SUBMIT TAB 5 Additional Comments amp Attachments Figure 15 Additional comments and attachments Additional Comments Pease note that the docs malice not conakdergd compete unti the atiaschmenots if are indicsted are recetred Ey ihe insure is mendatory aT documentwreports thal ate her sen i being sari if any Family physician report enclosed HCAI permits Facilities to do the following o Offer more information to Adjusters by using the space provided in Tab 5 o Advise Adjusters that additional documentation attachments is being sent which the Insurer requires to adjudicate the form Attachments must be faxed mailed directly to the Adjuster Where Should Attachments Be Sent Attachments must be faxed mailed directly to the Adjuster Attachments cannot be sent electronically and should be sent to HCAI To indicate that an attachment is being sent to the Adjuster tick the box beside Attachments being sent
7. Ji 3 Z CANCEL PRINT SAVE When you select a tab with an error a description will appear next to the field with the error see Figure 18 Figure 18 Error explanation Part 8 Other Reimbursable Goods and Services Approved by the Insurer Date Services Rendered D fenes Im 8 Mileage Provider 2009037 w Davis Wendy L Psr lest Onsite work Nome Code Provider Ref Quantity Measure Cost Proposed Tax 20
8. benefits Insurer is required to provide the injured person Claimant with a Claim number date of loss etc The insurance Policy number can be obtained from the pink slip that is provided when the auto insurance Policy is issued identifiers are used to identify the Claimant and match the document to a specific Adjuster s worklist When a form arrives at the insurance company the Insurer must match information contained in this section of the form Note Errors may delay insurer s ability to identify Claimant and subsequently process the Claim Four Key Identifiers Four key identifiers will assist insurers to quickly validate and adjudicate the Claim 1 Claim number and or Policy number Applicant must provide the Claim number if known the Policy number and the date of the accident o Claim number and Policy number can be obtained from the insurance Adjuster o The Policy number is also available on the Motor Vehicle Liability Insurance Card pink slip o The Claim number and Policy number may be the same 2 The accident date forms will not be processed without an accident date lf the Applicant has overlapping injuries from more than one accident use the date of the accident that is most relevant to the injuries being treated 3 Date of birth of the Applicant 4 Gender of the Applicant Invoice Identifier Information cannot be entered in this section in Tab 1 Part 1
9. pelvis hip Brand Allison B 8 1518 saa more tara 5 ers Use these buttons with the checkboxes on the left CONFIRM CODES Complete all fields except for the Provider Reference fields 2 Tick each box to the left of the each completed line item see red box in Figure 8 3 For each item click and select the name of the Provider from the dropdown list The Provider Reference will then be populated 12 TAB 4 Part 7 Reimbursable Block Fees within the MIG PAF if injury prior to Sept 1 2010 Guideline Figure 9 Search for MIG Codes TheCanadian Classification of Health Interventions referred to COL are developed by the Canadian institute for Health Information CHI tsa comprehensive list of codes for diagnostic therapeutic and support interventions For the purposes of the Automobile Insourance Industry number of codes were developed in canautatian with CIHI te complement the existing set of codes These codes are npled with an asterisk and are nat part of CCI GAP codes are developed by insurance Bureau of Canada in conjunction with automobile nsurers and health care providers tp cover those to automobile insurers by providers that are not covered by CCL that fall outside of the ream of a medical procedure intervention service are coded by using GAP codes These include goods supplies assistive devices mileage
10. dental psychological optometric 2 Amounts may be signed or unsigned a lf amounts are payable by another Insurer collateral source or the Claimant use a negative sign These amounts will be deducted from the amount owed by the Insurer b For amounts previously identified for payment by another Insurer but subsequently ruled ineligible use a plus sign or leave unsigned These amounts will be added to the sub total automatically 3 Click CALCULATE Totalling When all of the proposed goods and or services have been entered and any required fields in the Totalling section have been completed click CALCULATE calculates Tax HST and enters the amount into the Auto Insurer Total If you wish to manually enter a different tax amount for your invoiced goods services l Click and uncheck the button underneath the Totalling box ll Enter the new amount in the Tax if applicable field Click for the new Auto Insurer Total Figure 13 Totalling Totaling Proposed Cakculated Pre approved Sub totat 0 00 Other Goods and Services 20 00 Minus 0 00 Payment Received from Auto insurer Overtue Amount interest 0 00 Aulo insurer Total 20 00 t HCA popuistes the proposed and calcuasted tax columns with the HST rate 135 You may cvenwrte the Proposed Tax amount if you are Charging lax value thal different tram HST There are 11 lines in t
11. he GD goods measure Disbursements such as parking may be conveyed using Other AXXOT goods and the GD measure must be used Mileage expense must be conveyed using the KM kilometre measure not use GD for documentation review or preparation Attribute In addition to the 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 X ray study The absence of attribute codes means that a service was rendered directly in person to one individual by an individual Provider and required continuous attendance Refer to Appendix B for more information about attributes Provider reference Use the dropdown list to select the Health Care Provider who delivered care on a given date Insert one Provider for multiple line items There is a shortcut for inserting one Provider name in multiple line items as follows Figure 6 Apply one Provider to several line items Part 6 Goods and Services Rendered Providers are required to declare the information requested below on every treatment service and good delivered Failure to provide this information may delay payment Date Services Code Description Attr Provider Reference Quantity Measure Rendered feo 12 08 12 Therapy wrist joint Brand Allison B D12 08 14 Therapy elbow joint Brand Allison BJ 20 12 08 19 Repair nerve s af
12. his section Note that the field also compares the amount proposed on the Plan to the actual amount being invoiced It is possible to request payment for amounts greater than or less than those proposed on a Plan but the Insurer may request an explanation 17 e Lines 1 2 3 and 4 are populated by HCAI using the information entered o Pre approved Sub total sum of the cost of all pre approved services documented in Part 7 o Other Goods and Services sum of the cost of other goods and services as described in Part 8 o Minus MOH sum of all Ministry of Health and Long Term Care amounts This amount is taken from the Charged Services MOH line Amounts paid to you or expected to be paid to you are subtracted from the amount billed to the Insurer Amounts that you previously stated were available for you to receive but that you were unable to collect are added to the Insurer s Invoice o Minus Other Insurer 1 2 sum of all amounts received or payable to you from other Insurers This amount is taken from the Charged Services lines 2 and 3 Amounts paid to you or expected to be paid to you are subtracted from the amount billed to the Insurer Amounts that you previously stated were available for you to receive but that you were unable to collect are added to the Insurer s Invoice Line 5 represents Tax Lines 6 7 8 and 9 used as the basis for interest charges that have accumulated and will be calculated
13. ield o This number will appear in the HCAI worklist and will help you locate an Invoice after you have submitted it o dtis not a mandatory field and may be left blank Click Yes for First Invoice if your Facility has not previously invoiced the Insurer for the associated Plan Click Yes for Last Invoice if this is the last Invoice to be submitted for the associated Plan Previously Approved Goods and Services o Click Yes if the goods and services being invoiced are included in the associated Plan and type the Plan s Document Number If you do not have the Document Number select Yes and type exempt into the Document Number field FSCO s Guideline explains when it is appropriate to request an exemption f your Invoice includes goods and services that are not included in an associated Plan select No This indicates you have selected an exemption from providing a Document Number Part 4 Payee Information and Conflict of Interest Declaration When the HCF was registered with HCAI it will have chosen Yes or No to the question Lock Payables If the HCF selected Yes these fields will not be editable and the Facility s name and mailing address will be pre populated o If the HCF selected No the field next to Make Cheque Payable to must be completed Select Yes or No in response to the question Is there a conflict of interest TAB 3 Part 5 Inju
14. if any If this box is ticked the Facility must use the space below to describe the attachment being sent How do know my form has been submitted When your form is complete you may save it and a version will remain in the Invoices Draft sub tab for future use for this or another Applicant SUBMIT When you are ready to submit the form click the button at the top or bottom of Tabs 4 or 5 19 Figure 16 Successful form submission notice Create OCF21C C Eam Identifier Humbe 456 Date of Accident 2008 04 22 You submited document number 09032000009 Please note that ihe document is not considered complete unbl the attachments any ere indicated are recerved by the insurer CLOSE Figure 16 is an example of what you will see if your form has been successfully submitted to the Insurer Each form is assigned a unique Document Number by that can be used to track the form and distinguish it from others submitted for the same Applicant What if my form was not successfully submitted Look for the error message in orange HCAI validates data entered in the application as you move through the first four tabs Errors will be flagged by an orange tab see Figure 17 or through error messages in orange see Figure 18 Figure 17 Error notice orange tab Create OCF21C lt lt sre 4BACK NEXT User Manual
15. in Part 8 is described below Date service rendered Use the calendar utility to select the date on which the service was delivered or insert the date 15 Code Enter the intervention by typing it directly into the field under Code Or use the code search utility by clicking the blue button next to the Code field If using the Code search utility select GAP codes required to populate 8 are all GAP codes Attribute Refer to page 14 15 for information on Attributes Provider Reference Use dropdown list to select the health care Provider who delivered care To add one Provider to multiple lines refer to page 14 Quantity Measure Enter the quantity and unit measure of service that was provided during the Insurer approved intervention Cost Report the cost per service as described in the line Example lf the service was delivered for 0 5 HR the Cost column should reflect the cost to deliver that service by the provider listed for 0 5 HR Note Do not insert the hourly rate in this column You may also calculate costs using the Provider s default hourly rate Example 15 minutes of massage 0 25 HR by a massage therapist 25 of the RMT s hourly fee 0 25 x 53 66 13 41 This amount should be entered in the field under the Cost column Tax is applicable to a line item check the appropriate box es Part 9 Other I
16. into the total for your Invoice o Note Only the interest charges will be calculated into the total payable by the Insurer o Enter Prior Balance the Auto Insurer Total from your last Invoice o Subtract Payments Received since your last Invoice to calculate Overdue Amount o Enter the interest owing as a result of the Overdue Amount e Line 10 is the Auto Insurer Total the sum of all amounts in this section Tax Taxes are included in the MIG block billing fees The OCF 21C only permits taxes to be selected for line items in Part 8 Part 8 should not be used for MIG patients It only applies to PAF patients whose accident date is prior to Sept 1 2010 Prior Balance Overdue Amounts and Interest Charges o df your Facility has submitted an Invoice prior to the current Invoice but it has not been fully paid you may document the outstanding amount and associated interest on this Invoice o insert the Prior Balance which is the amount of the previous Invoice o Insert the amount of payment already received on the previous Invoice o Insert the overdue amount from the previous Invoice o Insert the tax as calculated on the overdue amount Important The overdue amount will not be added to the Insurer Total on this new Invoice Only the interest amount will be added to this Invoice The previous Invoice is still effective and amounts from prior Invoices should not be added to new Invoices 18 Additional Information
17. it can be viewed online and or printed There is no fee payable for completion of the standard Invoice Completion of an OCF 21C in HCAI Figure I Invoices global tab Mark s Healing Hands HCR T dia dede nue 5Suluncmed Allimenices CREATE MEWY Go to the Invoices tab any sub tab see Figure 1 Select OCF 21C from the dropdown list and click CREATE NEW A blank OCF 21C will open OCF 21C TABS The OCF 21C in HCAI appears organized under five tabs Figure 2 OCF 21C tabs Create OCF21C STEP Ni ERE ae 5 12 User Manual 3 CANCEL PRINT SAVE Tab 1 Claim Identifiers Invoice Identifier Part 1 Applicant Patient Information Part 2 Auto Insurer Information Tab 2 Part 3 Invoice details Part 4 Payee Information and Conflict of Interest Declaration Tab 3 Part 5 Injury and Sequelae Codes Part 6 Goods and Services Rendered Tab 4 Part 7 Reimbursable Fees within the PAF Guideline Part 8 Other Reimbursable Services Requiring Insurer Approval Part 9 Other Insurance Goods and Services Services Charged to Other Sources Additional Information Tab 5 Additional Comments and or Attachments 6 TAB 1 Claim Identifiers Speed up Claims Processing Persons who report injuries sustained in an automobile collision will be contacted by the Insurer to which they make the Claim for
18. nsurance Goods and Services Services Charged to Other Sources Figure 12 Other insurance Part 9 Other Insurance Goods and Services Enter the total amounts received or estimated to be payable to you on this invoice for goods and services from other insurance sources e g Ministry of Health and Long Term Care and Extended Health Care plans to which the applicant ix eligible Categorize amounts by Chiropractic Physiotherapy Massage Therapy and Other When the category Other is used specify the type of services covered e g dental psychological optometric Amounts may be signed or unsigned When you are indicating the amount payable not payable fram an Other Insurer Use a negative sign 1 to indicate the amount you have received or will receive directly from the collateral source or applicant This will alow collateral insurance payments to be subtracted from the sub total to determine the amount owed by the automobile insurer Chiropractic Physiotherapy Massage Therapy Other Services Total 0 00 Insurer 1 25n0 50 300 00 Insurer 2 0 00 ther Service Type Specified Occupational therapy CALCULATE 16 Note Amounts for services that have been paid or are estimated to be payable by other insurance sources must be entered with a negative sign 1 Categorize amounts by chiropractic physiotherapy massage therapy and other When the category Other is used specify the type of services covered e g
19. or Search for cades using the button Code Description B Sprain and strain of other and unspecified parts of shoulder girdle B Whiplash associated disorder 02 with complaint of neck pain with musculoskeletal signs A Injury of other muscles and tendons at shoulder and upper arm level CONFIRM CODES Refer to Appendix A which is the partial pick list of injury problem codes available at www hcaiinfo ca or contact your health professional association 10 Part 6 Goods and Services Rendered This section should list all dates and details of the specific treatment interventions rendered during the course of treatment for which the HCF is seeking payment At this stage payment information is not required Do not use the MIG or PAF block billing codes in this section Provide details of specific interventions that were delivered e g exercise education stimulation TENS laser US etc Important MIG PAF block billing codes and fees will be entered in Part 7 do not enter them here Important For Applicants with accident dates prior to Sep 1 2010 PAF Other Reimbursable Goods and Services e g Home Work School Onsite Intervention that required Insurer approval should be entered in Part 8 Figure 7 Goods and services lines Part 6 Goods and Services Rendered Providers are required ta declare the information requested below every treatment service and good delivered Failure ta pr
20. ovide this information may delay payment ahs DNE n Code Attr Provider Ref Quantity Measure d H XX MR B Riis m 100 PR E sco 3 1 00 PF Exercise spinal d see E niv 1 00 FR Education nrenmn Date service rendered All dates on which the Claimant attended treatment should be listed Dates should be formatted yyyy mm dd The calendar utility may also be used Code Enter the intervention by typing it directly into the field under Code Or use the code search utility by clicking the blue button next to the Code field see Figure 7 f using the search utility select either Canadian Classification of Interventions or GAP are international standard codes for health interventions However some services were not well represented in the therefore GAP codes were developed specifically for Ontario s auto insurance sector Quantity and unit measure Enter the quantity and unit measure of service that will be provided during a single treatment visit session Example 15 minutes 0 25 HR 1 procedure 1 PR 11 1 good like a back support 1 GD 10km 10KM 1 session 1 SN o important to use the correct unit measure that corresponds to the service described Most treatment interventions should use the PR procedure or HR hour measure All goods must use t
21. roval only for patients with an accident date prior to Sept 1 2010 Maximum Fee Payable by Service Insurer HR hour or PR procedure Onsite work home school See PAF Guideline review and intervention HR Negotiated between Health Care Travel time Facility and Insurer Negotiated between Health Care Mileage KM Facility and Insurer See PAF Guideline Transfer P WW TR PRO See PAF Guideline Complete each line of goods and services Completed lines in Part 8 will appear similar to those shown in Figure 11 Post PAF phase extension Figure 11 Other goods and services approved by insurer Part 8 Other Reimbursable Goods and Services Approved by the Insurer Other reimbursable goods and services must be within the Guidelines If HST applies to a good or service check the Proposed Tax checkbox on that line item Date Services Rendered 201008423 Anar Occupational PR 20100803 Occupational The 9 Code Provider Reference Quantity Measure O ooe BL G Occupational The 9 8 4 mE Je B Di 8 DELETE PROVIDERS Use these buttons with the checkboxes on the lett Add mare Items 9 Items CONFIRM CODES CALCULATE COSTS FROM RATES Completion of Part 8 is done similarly to completion of Part 6 The only difference is that you will assign costs and may assign Tax to services Completing lines
22. ry and Sequelae Codes Claimants treated in the Minor Injury Guideline MIG or in the Pre approved Framework PAF generally have an injury ies that is consistent with the MIG or PAF Guideline To learn how to search for injury codes refer to the HCAI Web User Manual which can be accessed on any HCAI web page by clicking 7 User anual F User Manual Create OCF21C ry 1 4 5 O G YT 9 a m m CANCEL PRINT SAVE Claim identifier provide he required ciam details Ether the Claim Number ar the Policy Number mus be provided as does the Date af Acciderd Cisim Number 12345 Date 2012 06 21 Source Web DateofAccident 20120801 F OCF Effective Date 2010 08 01 Policy Number 12345 Questions about coding Refer any questions regarding injury coding to your Health Care Provider association or access the website at www hcaiinfo ca Adding additional lines for injury sequelae codes To add lines for additional injuries simply click the sign near the bottom of the Part 5 box see Figure 6 Figure 6 Injury and Sequelae Part 5 Injury and Sequelae Provide the associated 0 10 code for injuries and sequelae listing the most significant first that are the direct result of the automobile accident Refer to the user manual at hcaiinfa ca for ICD 110 C4 coding information Use the Confirm Codes button ta set the codes and populate the descriptions
23. s If the injured person seeking treatment is the Policy Holder select Yes to the question Is the Policy Holder the same as the Applicant If the injured person is not the Policy Holder select No and enter the last name of the Policy Holder The name of the Policy Holder can be obtained from the pink slip of the proof of insurance form The Substitute Decisions Act states that a substitute decision maker is a person with power of attorney for personal care or a court appointed guardian TAB 2 Part 3 Invoice Details Figure 4 Invoice details Part 3 Invoice Details Ip aid process MERSE CENY pa for claimant thai i associated wih his invoice and whether nd PS Wace msi Provider invoice Number Fra hveice in TE Previously Approved Goods and Senices ap Bhd HERSE mies Is his invoice for goods and services described on an OCF 23 in HCAI Messe enter the Document Number of ihe Treatment Confirmaton Form OCF 23 to which this invoice corresponds Thi eleven digi bh n mend Number 1 ray Eie RR m ie i Prem 30 ni F moer H fhe i nl je mau t QCF 23 Document Number f your Facility uses an internal Invoice numbering system you may enter it in the Provider Invoice Number F
24. st you in understanding how to use and complete the forms OCF 21C CREATE INVOICE FROM SCRATCH Introduction In HCAI the Health Care Facility HCF has two options for OCF 21C creation 1 Create an OCF 21C from scratch When an OCF 23 has not been submitted by your Facility to the insurer through HCAI or Create an OCF 21C from a Plan that has previously been submitted via HCAI see the OCF User Manual for OCF 21C Create Invoice from an OCF 23 Previously Submitted via HCAI Who completes this form to prepare it for submission to the Insurer OCF 21s that are being prepared on the HCAI Web application must be completed by the HCF that is seeking payment by the Insurer The Applicant signature is not required What is the Insurer s role Fee After the HCF completes and submits the OCF 21 it will appear in the Invoices Work in Progress sub tab lt will appear in the Invoices Work in Progress worklist in the Submitted state until an Insurer user views the form o If the Facility has submitted a form in error the form can be withdrawn up until an Insurer user views the form After the Adjuster matches the form to the Claimant the form can be adjudicated At that point the form will continue to appear in the Invoices Work in Progress worklist however it will appear in the In Review state After the form is adjudicated the adjudicated form will move to the Invoices Adjuster Response tab where
25. travel time and independent medical Click ethar CCP or GAP codes the search select the Section that is appropriate for your cinical stuation To narrow down the search select an Intervention and a Group prior to clicking the Search bution 2006 Canadian institule for Health information Based upon the Internabonal Statistical Classification of Diseases and Related Health Problems Tenth Revesion ICD 10 Copyright amp World Heath Organization 1932 1354 All rights reserved Modified by permission for Canadian Government purposes try the Canadian Insitute for Health information If you search for codes for Part 7 make sure you select GAP see Figure 9 Include only MIG codes and fees here PAF codes only apply if the date of accident was or after Sept 1 2010 Note if PAF date of accident after Sept 1 2010 NOT include Home worksite school visit and intervention here Pre approved MIG Blocks are listed in Appendix B of the Minor Injury Guideline Pre approved PAF Blocks are listed in Appendix B of the PAF Guideline The codes for pre approved services are all GAP codes The maximum fees payable by Insurers for pre approved services are listed in the MIG PAF Guideline To learn which services are pre approved read the MIG Guideline published by the Financial Services Commission of Ontario and available on the FSCO website www fsco gov on ca 13
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