FSCO Service Provider Licensing

Service Provider licences became mandatory on December 1, 2014 for health facilities to bill auto insurers directly for certain services (“listed expenses”) invoiced through HCAI.

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Service Provider Licensing vs. Chiropractic Regulation

The College of Chiropractors of Ontario (CCO) is the body that regulates chiropractors in Ontario to ensure that patients receive quality care when visiting a chiropractor.  Every chiropractor practising in Ontario must be a registered member of CCO.

Service Provider Licences only reflect that a health care facility is licensed to receive payment directly from an insurer for care related to an MVA. This licence is in no way a commentary on a chiropractor’s competency or whether their care meets the requirements of the CCO’s Standards of Practice.

Key Resources and Contact Info

FSCO’s Key Resources

FSCO Information for PMP Users

These resources will help offices who use the OCA’s Patient Management Program to complete the Annual Information Return (AIR), calculate the annual licence renewal fee, and prepare for a FSCO audit.

Webinars and Videos

Contact FSCO

Principal Representatives may submit their questions in writing to:

Principal Representatives may also call the Contact Centre (416-250-7250) or contact their Senior Compliance Officer. Changes in licensing information (e.g. mailing address) should be reported to SPInfo@fsco.gov.on.ca.

Contact the OCA

The OCA is following FSCO Service Provider Licensing closely and is in contact with FSCO. Members may contact us at any time with questions or concerns about compliance, audits, how licensing is represented to patients, HCAI and more. Contact us by email at oca@chiropractic.on.ca or by telephone at 416-860-0070 (toll-free at 1-877-327-2273).

FSCO Examinations (Audits) of Licensed Service Providers

Based on a service provider examination, FSCO may take enforcement action against service providers who fail to comply with the law. For example: a service provider who fails to verify patient identity before an assessment or treatment may be subject to an administrative monetary penalty; a service provider who fails to submit the AIR will be subject to an administrative monetary policy, licence revocation or licence suspension. To ensure ongoing compliance, service providers should regularly review the Standards for Business Systems and Practices under Regulation 90/14 of the Insurance Act.

OCA members who have gone through a FSCO examination have reported that it was “very informative and educational rather than punitive,” and that “it was really good to sit down with FSCO to ensure our office was doing everything correctly.”

FSCO audits take 4–8 hours. You may not wish to schedule patients on the day of an audit, as the Principal Representative will need to be available during this time.

FSCO will send an information package in advance including a list of requested documentation. Some members have created a binder of this information in advance and reported that this was helpful. The documentation requested will be specific to MVA patient files, and will seek to verify licence compliance.

Health Service Provider Licensing Tookit for Examinations/Audits

The Coalition of Health Professional Associations in Ontario Automobile Insurance Services has provided a Health Service Provider Licensing Tookit for Examinations/Audits which includes the following information:

  • How FSCO chooses who to audit
  • Timelines and time required
  • What the examination covers
  • Privacy concerns
  • Sample policies and procedures which can be customized for your clinic

Download the Health Service Provider Licensing Tookit for Examinations/Audits now »

Learn more:

What is a Service Provider?

A “Service Provider” is a business (rather than a practitioner) that provides specified goods or services (“listed expenses”) for which it submits an invoice through Health Claims for Auto Insurance (HCAI) for payment by an auto insurer. These include health and rehabilitation clinics and providers of examinations and assessments on behalf of insurers.

Only one licence is needed for all facilities, branches or locations of a Service Provider that provides specified goods or services for auto accident claimants. A Service Provider’s business structure can be a corporation, partnership, limited partnership, or sole proprietorship.

Submitting OCF-21s and Getting Paid With or Without a Service Provider Licence

Whether or not they have a Service Provider Licence, chiropractors retain the right to treat auto insurance patients. All service providers continue to complete and submit the Auto Insurance Standard Invoice (OCF-21) through HCAI. Insurers continue to record their adjudication decisions in HCAI for all invoice submissions from licensed and unlicensed service providers.

Reimbursement following submission of the OCF-21 is now different for licensed and unlicensed service providers:

  • Insurers may pay licensed service providers directly on submitted OCF-21s in accordance with the SABS for goods and services provided on or after December 1, 2014.
  • Insurers are prohibited from paying unlicensed service providers directly on OCF-21s for goods and services provided on or after December 1, 2014. Unlicensed service providers are to:
    • Collect payment directly from the claimant. Whether you do this before or after they receive payment from their insurer is at your discretion.
    • Upon successful submission of the OCF-21 to HCAI, provide a hard copy to the claimant for submission to their insurer. The insurer will reimburse the patient. (Please note that you do not have to wait for an adjudication response before providing a copy of the OCF-21 to the patient.)

HCAI has developed a Business Process Change Guide with more details.

Watch HCAI’s video about this business process change for unlicensed facilities »

Revised HCAI Guideline

The Financial Services Commission of Ontario (FSCO) released a revised Health Claims for Auto Insurance (HCAI) December 2014 Guideline which applies to documents delivered on or after December 1, 2014. Revisions address the implementation of Service Provider Licensing, submission of Auto Insurance Standard Invoices (OCF-21s), frequency of invoicing and attendant care. Learn more about the revised guideline »

Applying for a Service Provider Licence

Read FSCO’s Service Provider Licensing Guide »

Apply now »

Key resources:

Licensing Fees

All licensees are required to pay an annual regulatory fee to cover the costs of regulating their business practices and an initial (one-time) licence fee. Once a licence is issued, it will continue indefinitely as long as the licensee files an Annual Information Return (AIR) every year and pays the annual regulatory fees.

Applicants pay two fees in the first year:

  • A one-time licence application of $337, and
  • An annual regulatory fee which is proportional to the size and nature of your business:
    • $15 multiplied by your business’s total number of unique SABS claimants in the calendar year before the year in which the application is made, plus
    • $128 multiplied by your total number of business locations at the time of application.

In subsequent years, service providers pay the annual regulatory fee alone. This fee is to be paid by March 31st of each year. Applications made throughout the year will be pro-rated based on a fiscal year cycle from April 1 to March 31.

Learn more about Service Provider licensing fees »

Annual Information Return (AIR)

The AIR is an annual questionnaire designed to collect specific information from service providers licensed by FSCO. This is a mandatory legal requirement for all services providers licensed by FSCO. The AIR must be filed electronically and may only be completed by the Principal Representative. At the time of filing the AIR, the PR will also have to pay the annual regulatory fee.

The Principal Representative must submit the AIR to the Superintendent no later than March 31st of each year, reporting information for the previous calendar year. The AIR must be filed using the PR’s online FSCO account.

Read FSCO’s FAQs about the AIR »

Why Service Provider Licensing Was Introduced

From 2006 to 2010 Ontario experienced a substantial increase in automobile insurance claims costs. The significant increase in costs was primarily attributed to increases in Statutory Accident Benefits (SABS) claims costs.

In the 2013 Ontario Budget, the government committed to take further action to address fraud in the auto insurance sector. Among other announced measures, the government signalled its intention to give FSCO the authority to license health clinics that invoice auto insurers and regulate their business and billing practices.

Bill 65, Prosperous and Fair Ontario Act (Budget Measures), 2013 establishes the legislative framework for FSCO to license and regulate Service Providers.

Learn more:

OCA Advocacy

The OCA is following FSCO Service Provider Licensing closely and is in contact with FSCO. Members may contact us at any time with questions or concerns about compliance, audits, how licensing is represented to patients, HCAI and more. Contact us by email at oca@chiropractic.on.ca or by telephone at 416-860-0070 (toll-free at 1-877-327-2273).

The OCA has continually advocated that while fraud reduction is a worthy goal, it should not come at the expense of health care providers. The OCA advocated that, as members of a regulated health profession, chiropractors should be exempt from this licensing process.