Standard healthcare invoice for Ontario auto

After five years of petitioning the Financial Services Commission of Ontario (FSCO), the Insurance Bureau of Canada (IBC) has instituted a standard auto insurance invoice for healthcare practitioners in Ontario. The invoice, which applies to rehabilitation providers such as chiropractors, massage therapists, psychologists, and the like, will take effect November 12, 2001. After that date, insurers have the right to refuse acceptance for invoices not done on the standard form.

The IBC says the form will make it possible to collect industry-wide data on accident benefit (AB) claims, a process that has been thwarted in the past by a plethora of different invoices being used. The paper-based invoice is a first step towards an electronic invoice system that would require healthcare providers to register themselves with the system and create a central data bank of information. “FSCO approval is a big step forward in achieving the insurance industry’s goal to gain control over spiraling healthcare costs,” says Mark Yakabuski, IBC’s Ontario vice president.

He notes that about $1 billion per year is spent by insurers on AB claims, but little is known about the nature of these claims. For example, as much as 40% of a provider’s invoice could be classified as “miscellaneous”, with little indication of what the insurer is paying for. He says the invoice will also make it easier for adjusters to make claims decisions and for providers to recognize alternate sources of payment, such as OHIP and employee benefit programs. As well, a database of information will facilitate fee negotiations with service providers.

The form applies only to direct bills sent by providers to insurers, and not to general practitioner and emergency services, such as ambulance, surgical and nursing services, or optical services.

The IBC is narrowing the field of potential contractors for an electronic invoicing system, and Yakabuski says this system could be up and running within 12 months if the proper regulatory approvals are given. While the paper invoice required only FSCO approval, the electronic system will require a change in legislation passed by the province. He hopes this change will be part of a package of changes expected to be proposed by FSCO soon. –