OCF-18: TREATMENT & ASSESSMENT PLAN - Manual for ... - HCAI

Table of Contents
DOCUMENT CHANGE HISTORY...........................................................................................................................2
INTRODUCTION.........................................................................................................................................................3
WHERE CAN I GET MORE INFORMATION? .......................................................................................................3
SAMPLES OF COMPLETED SECTIONS OF THE FORMS .....................................................................................3
WHEN DO I USE AN OCF 18 INSTEAD OF AN OCF 23 (PAF OR MIG CONFIRMATION) .....................................3
WHO COMPLETES THIS FORM TO PREPARE IT FOR SUBMISSION TO THE INSURER?............................................3
WHO HAS TO SIGN THE OCF 18?..................................................................................................................3
HOW DO I KNOW THE DATA ENTRY CENTRE (DEC) RECEIVED MY FORM? .......................................................3
HOW DO I KNOW THE DEC SUBMITTED MY FORM TO THE INSURER? ................................................................4
WHAT IS THE ROLE OF THE DEC IN MY ELECTRONIC SUBMISSION? .................................................................4
WHAT IS THE INSURER’S ROLE? ...................................................................................................................4
WHAT IF THERE IS TO BE SIMULTANEOUS TREATMENT BY MULTIPLE HEALTH PROVIDERS IN THE SAME HCF? .....4
FORM COMPLETION FEE ..............................................................................................................................4
COMPLETION OF AN OCF 18 FOR HCAI DEC PROCESSING.......................................................................5
CLAIM IDENTIFIERS – SPEED UP CLAIMS PROCESSING...................................................................................5
Four Key Identifiers .............................................................................................................................................5
PART 1 APPLICANT INFORMATION ...............................................................................................................6
PART 2 INSURANCE COMPANY INFORMATION .........................................................................................6
Independent Adjusting Companies and Adjusters..........................................................................................6
PART 3 OTHER INSURANCE INFORMATION ...............................................................................................6
PART 4 SIGNATURE OF HEALTH PRACTITIONER .....................................................................................7
IF YOUR HCF REQUIRES AN EXTERNAL (NOT ASSOCIATED) HEALTH PRACTITIONER’S SIGNATURE IN PART 4......8
Health Practitioners .............................................................................................................................................8
Regulated Health Professionals ........................................................................................................................8
What is an “Associated Provider” ......................................................................................................................8
PART 5 SIGNATURE OF REGULATED HEALTH PROFESSIONAL..........................................................2
“Is the health practitioner also the regulated health professional?”..............................................................2
PART 5 – PLAN SUPERVISION.......................................................................................................................2
When and why is a Signature Required in Part 5?.........................................................................................3
PART 6 INJURY AND SEQUELAE INFORMATION.......................................................................................3
QUESTIONS ABOUT CODING?........................................................................................................................4
Coding Tips:..........................................................................................................................................................4
PART 7 PRIOR AND CONCURRENT CONDITIONS......................................................................................5
PART 8 ACTIVITY LIMITATIONS.......................................................................................................................6
PART 9 PLAN GOALS, OUTCOME EVALUATION METHODS AND BARRIERS TO RECOVERY .....6
PART 10 SIGNATURE OF APPLICANT .............................................................................................................7
PART 11 HEALTH CARE PROVIDERS ..............................................................................................................8
PART 12 PROPOSED GOODS AND TREATMENT SERVICE.......................................................................8
Goods/Service Reference (G/S)........................................................................................................................8
Description............................................................................................................................................................9
CODE AND ATTRIBUTES................................................................................................................................9
PROVIDER REFERENCE ................................................................................................................................9
Multiple providers delivering one services .......................................................................................................9
ESTIMATED..................................................................................................................................................9
Projected Total Count .......................................................................................................................................10
Projected Total Cost..........................................................................................................................................10
Totals...................................................................................................................................................................10
Attachments........................................................................................................................................................10
PART 13 SIGNATURE OF INSURER ................................................................................................................11
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