What prompts Universal Office to produce a warning when attempting to go outside boundaries of the Frequency of Invoicing SABS rule? We get that question a lot, so we felt it was time to clarify the confusion.
The rule was first introduced in 2011, in an effort to reduce the high volume of paper received by insurers. The guidelines read as follows:
“The new Guideline requires that invoices be submitted only once a treatment plan has been completed, or once every 30 calendar days if the treatment extends beyond a month.” (See the Frequency of Invoicing heading in Bulletin No. A-07/11.)
According to Wikipedia, “a calendar day is any day of the week, including weekends.”
In December of 2014, FSCO announced an amendment to the rule. As described, FSCO decided to make the change in response to feedback from stakeholders (see the Frequency of Invoicing heading in Bulletin No. A-12/14, or you may also want to reference the Requirements for Submission of the OCF-21 section on page five in the Health Claims for Auto Insurance Superintendent’s Guideline No. 04/14). It now reads like this:
“An OCF-21 submitted in respect of a Treatment and Assessment Plan (OCF-18) shall not be submitted until no further approved goods or services referred to in the OCF-18 will be rendered. However, where the delivery of the goods or services referred to in an OCF-18 extends over 30 calendar days, the Service Provider may choose to submit an OCF-21 in respect of that OCF-18 not more than once per calendar month.
“In order to enable insurers to properly reconcile invoices, a Service Provider shall not submit an OCF-21 that applies to more than one OCF-18 or to more than one OCF-23, or to an OCF-18 as well as an OCF-23.
“If treatment is being provided under the Minor Injury Guideline (MIG), a Service Provider shall not submit an OCF-21 in respect of a treatment Block as referred to in the MIG until completion of the Block. (In the event an insured person changes providers while treatment services are being delivered, the previous provider may submit an OCF-21 for the services delivered prior to the change. However, the amount billed must comply with paragraph 6 (“Changing health practitioners within this Guideline”) of the MIG.)”
Long story short – the regulation has changed to make sure that you invoice once per calendar month for goods and/or services referred to an OCF-18, where it takes more than 30 days (or calendar days) to be delivered to the patient. When you attempt to submit more than one OCF-21 to HCAI for the same Treatment and Assessment Plan (OCF-18) or Treatment Confirmation Form (OCF-23) within a calendar month, Universal Office will prompt a warning message.
