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New requirement for treatment provider licenses for MVA billing under accident benefits

As of December 1, 2014, service providers who submit OCF-21 forms through Health Claims for Auto Insurance (HCAI) must be licensed with the Financial Services Commission of Ontario (FSCO) to invoice and receive direct payment from automobile insurers for specific “listed expenses” in connection with statutory accident benefits.

“Listed expenses” are the assessments, examinations, reports, forms, plans, goods and services that need to be billed through Health Claims for Auto Insurance (HCAI) [New Window] on an Auto Insurance Standard Invoice (OCF-21).

A service provider will need a licence to submit invoices through HCAI and to receive direct payment from automobile insurers for these listed expenses.

Automobile insurers will not be allowed to pay a service provider for listed expenses in connection with goods or services provided on or after December 1, 2014, if the business or legal entity does not hold a service provider’s licence as of December 1, 2014.

Below, please find an excerpt from the FSCO website re: the new licensing requirement for clinics (the FAQ’s are at: http://www.fsco.gov.on.ca/en/service-providers/Pages/faqs.aspx#q17)  and the need to apply by August 1 to receive a decision before the December deadline.

 

Apply Now for a Service Provider Licence

To ensure a licensing decision by November 30, 2014, your business must apply for a service provider licence before August 31, 2014.

Service providers that do not submit licence applications prior to August 31, 2014, may not receive licensing decisions prior to November 30, 2014.

An instructional video and online guide are available to assist all applicants. Select the appropriate link below based on the legal structure of the service provider’s business to begin the application process: Sole Proprietorship Partnership Corporation Note: Principal Representatives will be required to create a FSCO Account before proceeding to the service provider application.

Apply Now

Select the appropriate link below based on the legal structure of the service provider’s business

to begin the application process:

 

Sole Proprietorship   |   Partnership   |   Corporation

 

Login to your existing FSCO account

If you have a FSCO Account and/or have started your application

login to your FSCO Account to continue with the application process.

 

Note:

Principal Representatives will be required to create a FSCO Account before proceeding to the service provider application.

 

 

As of December 1, 2014, service providers who submit OCF-21 forms through Health Claims for Auto Insurance (HCAI) [New Window] must be licensed with the Financial Services Commission of Ontario (FSCO) to invoice and receive direct payment from automobile insurers for specific “listed expenses” in connection with statutory accident benefits.

 

FAQ: What is a Service Provider?

FAQ: For which listed expenses will service providers require a licence in order to receive direct payment from auto insurers?

 

Service provider licences will be issued at the business or legal entity level (e.g., sole proprietorship, corporation, partnership). This means that only one licence is needed for all facilities, branches or locations operated by a service provider that provide specified goods or services to statutory accident benefit claimants.

 

A service provider’s business structure will take one of the following forms: Sole Proprietorship; Partnership (General and Limited); or Corporation.

 

The Role of the Principal Representative

 

Prior to applying for a licence, the service provider must designate a Principal Representative.

 

FAQ: What is a Principal Representative?

The Principal Representative will be accountable for completing and attesting to the application being submitted to FSCO.

 

If the licensee is a:

 

Sole proprietorship – The Principal Representative is the sole proprietor.

Corporation – The Principal Representative is a director or officer of the corporation.

Partnership – The Principal Representative is a partner.

Limited partnership – The Principal Representative is a general partner or a director or officer of a corporation that is a general partner.

The Application Process

 

The service provider licence application consists of four (4) parts:

 

Part 1 – Basic Information about the Business

Part 2 – Suitability of the Principal Representative and people in the Business

Part 3 – Annual Information Return (AIR)

Part 4 – Consent and Attestation

Before Applying

 

The service provider and all its branches, locations and/or facilities must be enrolled in HCAI.

The service provider must appoint a Principal Representative, as required by law, to complete the application and attestation.

Ensure your business’ Principal Representative has the following information on hand before submitting a service provider licence application:

An Ontario mailing address that is suitable for receiving registered mail (not a post office box).

An email address.

Information about each facility, branch, or location registered with HCAI (such as: names, addresses and registration numbers) that will be listed under the service provider’s licence.

Articles of Incorporation or Partnership Agreements (for a corporation or a partnership).

Your Canada Revenue Agency business number.

Your Ontario business registration number, if applicable.

Contact information of all officers, directors or partners of the business.

The number of regulated and unregulated practitioners, by profession.

Consult our FAQs for more information regarding the licence application process.

 

Application Fees

 

When applying for a service provider licence, applicants will be required to pay a two-component fee consisting of:

 

A one-time licence application fee of $337

This one-time fee covers the cost of assessing the application for satisfaction of the regulatory requirements, and determining whether the applicant qualifies for a licence.

An annual regulatory fee

This annual regulatory fee covers the cost of regulating the service provider sector. It is proportional, and varies based on the size and nature of the applicant’s business.

 

Each applicant’s regulatory fee is calculated according to the following formula:

 

$15 multiplied (x) by the total number of unique statutory accident benefit claimants in the calendar year before the year in which the application is made.

 

plus (+)

 

$128 multiplied (x) by the applicant’s total number of business locations at the time the application is made.

 

This regulatory fee is prorated, based on a fiscal year cycle that begins April 1 and ends March 31. For example, if the applicant is applying to obtain a licence that is effective December 1, 2014, the fee would be prorated for the period December 1, 2014 to March 31, 2015 (four months).

 

Using this same example, the full annual regulatory fee would be payable by the licensee beginning in April 1, 2015, and every year thereafter, as directed by FSCO.

Consult our FAQs for more information regarding fees.

 

More Information

 

For more information about service provider licensing, remember to:

 

Check out the Service Providers – What’s New section of our website

Consult our Online Guide and Instructional Video

Consult our FAQs

Subscribe to our Service Providers eNewsletter

Follow us on Twitter @FSCOTweets [New Window]

Questions?

 

Telephone: 416-250-7250

Toll free: 1-800-668-0128

Fax: (416) 590-7070

TTY: 1-800-387-0584

Email: contactcentre@fsco.gov.on.ca

About The Author

Personal Injury Lawyer-Whitby

Steven Polak is a personal injury lawyer in Whitby, Durham and Toronto Ontario who works as part of the team of over 100 lawyers at Lerners LLP, he assists injury and disability victims with motor vehicle accident lawsuits, accident benefits cases, disability benefit denial cases, slip and falls, and other injury claims.

Number of Entries : 92

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