Welcome to our guide on billing MVA claims to HCAI in Ontario! Just like any other third-party insurer, you can submit claims through HCAI’s portal outside of Jane, and then manage those claims within Jane.
This workflow is ideal for clinics that are just starting out with billing to HCAI and aren’t currently using the Block Billing workflow.
Here’s what we’ll cover in this guide:
- Setting up the insurer
- Creating a patient policy
- Adding a claim to the appointment
- Managing the insurer invoice
- Managing the claim
- OCF forms
- Adding Extended Health Care Benefits
Setting up the insurer
In order to track and manage your MVA claims, you’ll need to set up an insurer in Jane for each of the motor vehicle insurers that your patients may have coverage under. Insurers can be created by heading to Settings > Insurers > New Insurer:
Next, you’ll want to select Regular Insurance/3rd Party Payer/Lawyer. This lets Jane know that you’ll be submitting claims through the HCAI portal outside of Jane.
From here, you’ll enter the insurer’s name details. For this example, we’ll use Intact, a motor vehicle insurer billed through HCAI’s portal.
You may also find it helpful to include the link to the HCAI portal in the Portal URL field. This will help you launch HCAI’s portal right from Jane instead of opening a new tab on your web browser.
HCAI’s portal URL is: https://www.hcai.ca/HCAI.Web/Login.aspx
You can read more about setting up an insurer here.
Creating a patient policy
Once you’ve added the insurer, you’re ready to begin creating patient policies and adding claims to appointments.
From the schedule, you can select the patient’s appointment you’d like to add a claim to. On the Appointment Panel to the left, under Insurance Info, select Add Policy > Add New Policy.
Next, you’ll want to choose the insurer and add in the policy information.
The only required field is the Claim/Identification Number which you can name after the MIG block you’re billing. This will help later on when you’re applying the lump sum payment to all the claims in a certain MIG block.
You can add a policy maximum, end date, and adjuster details to the middle section.
Adding a claim to the appointment
After saving the claim, it’ll be attached to the appointment under the Insurer Info section on the Appointment Panel.
If you entered a policy maximum or end date when you created the policy, Jane will alert you in the appointment panel when the value/date has been reached.
Managing the insurer invoice
MVA claims can be managed like any other claim submitted through a portal outside of Jane.
From the Schedule tab, click on the appointment to open the appointment panel. At the top of the panel just below the patient’s name, you’ll see the insurer’s name in blue.
When you click on the blue text, Jane opens the policy page.
💡 Jane tip: If you’ve added the link to the HCAI portal in the “Portal URL” field of your MVA insurer, then you can launch the portal from this page.
After submitting the claim, you’ll want to scroll down a bit on the page to view it within Jane. Click the dropdown arrow to the right of the claim and mark the invoice as Submitted.
You’ll see the claims status update right away.
Now you wait for payment 💸
Managing the claim
To best way to see claim details like end date, policy maximum, and total billed is by viewing the policy.
You can view the policy either from the schedule by selecting the patient’s appointment and then clicking on the insurer’s name in blue text below the patient’s name:
You can also view the policy from the patient’s profile > Billing > Insurance Policies > View:
From here you can see the Claim End Date:
You can also see the details of the claim to date, like amounts billed and paid, and visit counts:
You can add notes or Tasks to create reminders regarding a specific claim/policy.
Plus, you can view all of a policy’s claims in one place.
OCF forms
The OCF forms are an essential part of your MVA claims.
You can find a list of downloadable PDF versions of OCF forms as well as information on filling out, submitting, storing, and tracking each OCF here.
The OCF forms cannot be filled out within Jane, but if you are working with fillable PDF forms that you have downloaded from the HCAI website and would like Jane to help give you a bit of a head start filling out some of the fields, check out our guide on Fillable Forms for more information.
Adding Extended Health Care Benefits
If a patient has Extended Healthcare Benefits, you can add their EHB policy onto each of their appointments first as the primary policy. You can use the Eligible Amount or Max Amount field to indicate how much the insurer will be covering for each visit.
Next, you’ll add on the MVA Insurance policy as the secondary policy.
When you submit to their EHB provider, you’ll update the eligible amount field on the claim right away.
At the end of each MIG block, you’ll receive the lump sum covered by the auto insurer and you can use that to calculate how much the auto insurer is covering per visit.
All done!
I hope this guide has been helpful. If you have any questions or need a hand, don’t hesitate to contact us, and we’ll be happy to help.