Health Claims for Auto Insurance Things you need to know

Health Claims for Auto Insurance: Things you need to know…. OSOT AGM September 29, 2006 Viivi Riis Senior Health Analyst Insurance Bureau of Canada 1 HCAI: Learning Objectives After the workshop, participants will be able to: 1. Discuss the rationale and background for development of HCAI Consider the impact HCAI may have on individual practice and on the profession in general Consider the potential of HCAI to standardize and improve quality of data practices in auto insurance rehabilitation sector Plan for implementation of HCAI in their practice(s) Know where to go for help 2 2. 3. 4. 5. Agenda What Who Why When How Demo of HCAI Q&A 3 What is HCAI? Health Claims for Auto Insurance (HCAI) is a system that allows for online submission, review and approval of key auto insurance claims forms 4 HCAI: What System will reflect: HCAI regulation SABS regulation Self-serve provider enrolment (like AISI) 5 HCAI: Development Development HCAI working group consisting of representatives of FSCO, health provider associations and IBC meet regularly Privacy Ontario Information Privacy Commissioner has reviewed FSCO’s Privacy Impact Assessment of HCAI 6 HCAI: History Timeline 2000 2001 2003 Data Need CDN. Institute for Health Information (CIHI) Justice Adams Report Standard Invoice Form Harmonized Treatment Plan and Invoice, PAF forms Regulators FSCO Working Group on forms Bill 198 Development RFI to develop system Document business requirements Sapient chosen Objectives: 1. Collection of data to study and evaluate the system 2.Transactional efficiency between providers and insurers 7 7 HCAI: Who will be affected: Any health professional engaged in the provision of services in the Ontario auto insurance health sector 8 HCAI: Why Property & Casualty Insurance is the single largest private payer of outpatient medrehab services ($1.5 billion per year in Canada) System is “benefits-based” – the regulations under the Insurance Act require the insurer to make claims decisions on reasonable and necessary care 9 HCAI: Why BUT, we don’t have the facts: Health professions, insurers and insurance regulator (FSCO) have limited data upon which to base recommendations or decisions around regulatory reforms affecting health services Health services researchers also need data to facilitate research on rehabilitation for MVA victims 10 HCAI: Why HCAI is the start of a solution to the administrative and health data deficiency in this $1.5 Billion health care sector HCAI can deliver: High data accuracy High data integrity High level of data completeness HCAI has potential to evolve to collect meaningful health information 11 HCAI: Why What’s in it for me? Chance to move the private auto rehab/insurance industry to a single electronic platform with potential future benefits for your practice, your profession and health research Professional associations will receive some support to assist with implementation 12 Why HCAI? What’s in it for me? Improved claim form management from insurers : • No more “lost” forms/invoices. Avoid delays in form submission • Time tracking • Plan Approval: Instant access to insurer determinations • Communications Tool: Less telephone tag with insurers. • Historical Forms Access: Storage of plans, invoices and adjuster responses. • First step in collection of reliable health claims data. Standardized reports • Raw depersonalized data will be accessible to researchers (with appropriate authorizations) • 13 HCAI: When 1. 2. Anticipate regulations pertaining to HCAI will be passed in fall/winter 2006 Pilot will launch shortly after regulations are passed. After a lead time expected to be a year, all OCF 18s, 22s, 23s and 21s must be transacted through HCAI 3. 14 HCAI: What’s the “Pilot” Objective: to establish a small manageable business environment that will: Build confidence in using HCAI Enable fine tuning of the HCAI application Allows users to start using and learning about the system Health professional participation is voluntary during the Pilot HCAI will operate in tandem with existing paper processes 15 HCAI: What’s the “Pilot” Seven insurers Gore, ING, Security National, RBC, State Farm, Unifund Assurance and belairdirect Targeting at least 100 health care providers/clinics Locations Central/west Ontario (Hamilton, Burlington, London) GTA Interested in participating in the pilot? Go to the website http://www.hcaiinfo.ca/contact.asp 16 HCAI: How? “I think you should be more explicit here in step two.” 17 HCAI: How can data be submitted? 1. PMS Practice Management Systems that have been validated to submit to HCAI can submit OCFs via an Electronic Data Interface (EDI) 2. Web OCFs can be submitted over the Internet via the secure HCAI website 3. Data Entry Centre Will be available 3 months prior to full implementation. At that time, OCFs can be sent to a central data entry centre for entry into HCAI 18 Populating the Med/Rehab database Approval/ payment decisions Data submitted via web/EDI/DEC Data edits validation Insurer Health Care Provider Database FSCO and stakeholders working to develop processes to make standardized reports and anonymized data available to stakeholders and researchers. 19 HCAI: How Will I still be able to submit paper forms? Yes. A Data Entry Centre (DEC) will be established to: Receive paper forms – unknown at this time how many methods will be accommodated, e.g. mail, fax, email, etc. • Transcribe into electronic form and submit to HCAI • Insurers will pay to establish the DEC In time there may be advantages to being able to submit electronically (web or EDI/PMS) A competitive bid process will define cost aspects of paper submission – i.e. we don’t know what the costs will be at this time 20 HCAI: How No change to how you currently handle medical documents or attachments that are sent in with your forms: I.e. medical reports/assessments/attachments will still be sent outside of HCAI (fax, secure email, snail mail). HCAI has capacity to transmit executive summary from medical/assessment reports as part of claim form (up to 5 pages of text) 21 HCAI: Practice Management Software (PMS) Users HCAI has had ongoing communication with PMS vendors regarding HCAI integration Focused on systems used by clinics that treat patients injured in auto collisions PMS Vendor group has been working with IBC on implementation details Several Practice Management System (PMS) vendors have signed PMS working group commitment letters 22 HCAI: Practice Management Software (PMS) Users To view the list of vendors who are currently participating and have agreed to have their name listed on the website http://www.hcaiinfo.ca/hp-pmsvendors.asp 23 HCAI: Challenges Evaluate your current technology Plan for the transition – some parallel processes (i.e. for a time some insurers will be on HCAI but others will not) What is your facility’s or practice’s technological capacity? Does everyone have a PC – how old, how current is software, access to high-speed internet, email addresses • It will be help if staff are familiar with Windows based applications, internet, etc. • Back up planning – consider processes in the event that your own technology is unavailable. 24 HCAI: Challenges Varying practices in different facilities/clinics Clinics will need to consider best integration of HCAI with their existing business practices. HCAI will mirror the existing paper system Data collected will reflect the data provided on the present forms Expect a learning curve as your clinic adjusts to most efficient use of HCAI system. 25 HCAI: Challenges Communication: Make sure you get the right answers. Don’t rely on rumour – contact the HCAI team at providersupport@hcaiinfo.ca 26 http://www.hcaiinfo.ca/ 27 27 HCAI: Support Initial support Pilot provider training to be organized immediately (group format) Province-wide information sessions (Pilot and non-Pilot providers) to be scheduled soon after regulations passed Webcast Ongoing support FAQs Helpdesk for providers (phone in and email) 28 28 HCAI: Support Training materials User manuals Train the trainer sessions will be offered to health professional associations HCAI team available to provide information sessions organized by health professional associations Web materials to be posted NB: HCAI team NOT able to offer individual sessions to practitioners or facilities 29 29 Screen Demo 30