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Smart Approach to MVA Dispute Preparation

Last year, FSCO announced that as of April 1, 2016, new accident benefit claims are to be adjudicated by The License Appeal Tribunal (LAT). Since then, more supporting medical documentation was added to the checklist – leaving many dreading the preparation for MVA disputes, previously known as the mediation.

Those who invest their time and effort into doing it right know just how tedious and time-consuming this task can be. We are aware that preparing this information doesn’t come easy. Here are some common challenges practice management faces as requests to prepare for disputes flow in:

Preparing Information for Dispute

  1. Conduct a list of submitted OCF-3s (Disability Certificate), OCF-18s (Treatment and Assessment Plans), and OCF-23s (Treatment Confirmation Forms) with proposed and approved amounts.
  2. Create a table of OCF-21s with billed, approved and paid amounts.
  3. Make sure that there are no hanging unbilled services. If there are, invoice those by creating an OCF-21.
  4. When patient has extended health benefits, it is important to apply EHC payments to MVA invoices upon being received. Keep them in check for account balance accuracy.
  5. Include clinical notes for every provided service. Double-check to make sure that all clinical notes are signed by respective service providers.
  6. Find out whether you or those who work with you on the case (for example, an assessment centre) have anything outstanding for performed assessments.

Analyzing Collected Information

  1. Were invoices for completion of OCF-3s issued, paid or declined by insurer? Now is the time to catch up on that.
  2. Were submitted OCF-21s for approved or partially approved OCF-18s and OCF-23s paid by insurer? If not, prepare a list of outstanding invoices associated with those.
  3. Was a patient approved for transportation or interpreter services? Were those services invoiced and paid? If they were not included in the approved OCF-18s, check case notes for verbal or written approval from insurance adjuster.
  4. For denied OCF-18s, see if Insurer Examination was done. If so, check whether proposed services were approved, partially approved or denied. Compare the value of provided treatments to what was paid.
  5. Look for overdue balances. Insurance companies (including a new addition to HCAI MVACF – Motor Vehicle Accident Claims Fund) are obligated to pay for accident benefits within 30 days of the invoice receipt, as it states in Bulletin No. A-03/15 on the FSCO website. You can find the bulletin highlights on our blog post. With invoices overdue 30 days or more, you are entitled to apply accumulated interest on top of the unpaid amount. Our How to Add and Manage Interest Charges article will help you with that.

Tip: Often, the effort put into recording clinical notes is overlooked and goes unpaid. To ensure payment, issue an invoice addressed to the legal rep and request payment upon receipt.

After learning about the obstacles our customers go through, we wanted to help streamline this process. It is overwhelming reading the steps above, and even more so going over them every day. The good news is that in Universal Office, most steps can be completed with a click of a button! Once again, Reports Manager comes to the rescue. It saves countless hours spent on summarizing the required data by extracting desired information instantly.

Relevant Reports

We have put together a list of report templates that can help you speed up the preparation process for disputes. If you are not already using them, you can find them in our Online Templates Library available for free, right from within the Reports Manager module.

To learn how to download reports from our free Online Templates Library, please refer to the Generate Reports, Import and Export Templates knowledge base article.

We are positive that these tips and reports will help make the MVA dispute process a little easier. Let us know how you cope with such an exhausting, yet extremely important, task – we’d love to hear your approach!