HCAI · Billing integration
OCF forms, submitted and tracked to the adjuster’s answer.
Ontario auto-insurance work runs on OCF forms and adjuster approvals. Clinicmaster builds the treatment plans and invoices, submits them to HCAI, and brings the adjuster response back onto the case — so you know what was approved, what was refused, and what is still waiting.
The HCAI integration
HCAI (Health Claims for Auto Insurance) is the system Ontario clinics use to send treatment plans and invoices to auto insurers and receive adjuster decisions. Clinicmaster builds the OCF forms from the case, submits them to HCAI, and retrieves the adjuster responses — including approvals, adjustments and refusals — so the status of each plan and invoice is visible on the case rather than in a separate portal.
What the HCAI integration does.
The OCF form set is the work. Building it from the case — and knowing what came back — is where the time goes.
The full OCF form set
Treatment plans (OCF-18 and the pre-approved OCF-23), invoices (OCF-21B for goods and services, OCF-21C for pre-approved framework fees) and the OCF-3 disability certificate are all built in Clinicmaster.
Submitted to HCAI from the case
Plans and invoices are submitted to HCAI directly from the case they belong to, so nothing has to be re-entered into a separate portal.
Adjuster responses retrieved and acknowledged
Responses are pulled back, processed against the plan or invoice they answer, and acknowledged — so an approval or refusal is recorded where the treating clinician can see it.
Status tracked per transaction
Each submission carries its own transaction status, which is what lets you tell the difference between waiting on the adjuster and needing to act.
Pre-approved framework fees distributed
For PAF cases, reimbursable fees are distributed across the OCF-21C invoice rather than being apportioned by hand.
Insurer and practitioner lists kept current
The insurer and health-practitioner reference lists are refreshed from HCAI, so submissions go against current registered entries instead of a stale local copy.
From treatment plan to adjudicated invoice.
The treatment plan is built and submitted.
An OCF-18, or an OCF-23 for pre-approved framework care, is produced from the case and submitted to HCAI for the adjuster to consider.
Approved care is invoiced on the right form.
Delivered services are invoiced on an OCF-21B, or an OCF-21C where pre-approved framework fees apply, built from what was actually recorded.
The adjuster’s answer lands on the case.
Responses are retrieved, processed and acknowledged, and each submission’s transaction status shows whether it is approved, adjusted, refused or still outstanding.
What this integration does not do
One honest limit worth stating: Clinicmaster tracks the adjuster’s decision on the case, but posting an approved amount as a payment on the patient ledger is a separate step — the HCAI integration does not claim to post insurer payments automatically the way the real-time private-insurer integrations do. Approval decisions, guideline rules and what an insurer pays are governed by HCAI and the insurer. HCAI registration is arranged separately.
The HCAI workflow inside Clinicmaster.
Auto-insurance work is a sequence of approvals. What matters is that each form, each response and each status stays attached to the case it belongs to.
Back to regional billing- OCF-18 treatment plan
- OCF-23 pre-approved plan
- OCF-21B invoice
- OCF-21C PAF invoice
- OCF-3 disability certificate
- Submission to HCAI
- Adjuster response retrieval
- Transaction status per submission
- Insurer & practitioner lists
HCAI billing questions.
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