The Financial Services Regulatory Authority of Ontario (FSRA) regulates the business systems, and billing practices of service providers as outlined in the Standards for Business Systems and Practices regulation.
Annual Information Return
The Annual Information Return (AIR) is a reporting form that must be filed once a year by the Principal Representative. The AIR collects information about the service provider’s business systems, practices and controls, in connection with billing for listed expenses in the previous calendar year. This includes information about unique Statutory Accident Benefits Schedule (SABS) claimants.
To file an AIR, login to your FSRA account.
For more information on the latest AIR, please see Filing an Annual Information Return.
Annual regulatory fee
Licensed service providers are required to pay an annual regulatory fee (ARF). The ARF covers the annual cost of regulating the service provider sector, and is paid in advance by the Principal Representative.
To pay the ARF, login to your FSRA account.
For more information about the ARF, please see licence fees.
Maintaining your licence
An important part of maintaining a service provider licence is meeting the standards for business systems and practices described in the SABS. According to these requirements, among other things, all licensees must:
- Respond to insurer requests within 10 business days for certain information, such as the service provider’s licence number, and who is authorized to provide goods or services on its behalf.
- Ensure that each facility, branch or location is enrolled and in good standing with Health Claims for Auto Insurance (HCAI).
- Comply with the requirements of the HCAI Guideline.
- Use only approved forms, under the SABS.
- Ensure no invoices or other documents are submitted to HCAI if the service provider has reason to believe they contain inaccurate, false or misleading information. If doubts arise after documents have already been submitted, the service provider must inform the insurer at the earliest opportunity and provide it with the correct information.
- Conduct periodic reviews of documents submitted to insurers (as described in the regulation) to ensure compliance with the legislation and applicable guidelines, and reconciliation of billings.
- Retain in electronic or paper form any goods and services records provided by or on behalf of the service provider, related to listed expenses for at least six years from the date a record was created. Records must be retrievable within five business days of receiving a request.
- Establish and implement policies and procedures appropriate to the nature, and volume of the service provider’s business under the SABS.
- Report to FSRA certain important changes in the service provider’s business within five business days (see below).
- File an AIR to FSRA every year (see above).
Changes that must be reported
Licensees must report any changes to the following information within five business days:
- Mailing address in Ontario
- Email address, telephone or fax number
- Location of principal place of business or any facility, branch office or location in Ontario
- Facilities, branch offices or locations opened, closed, acquired, amalgamated or transferred in Ontario
- Principal Representative
- Directors, officers or partners, as applicable
All the changes listed above can be requested by logging into your existing FSRA account and completing an update application. Except for changes to email address, telephone or fax numbers, which should be reported to FSRA by email to [email protected].
What information can an automobile insurer request from a service provider?
The service provider must give the following information to the insurer, upon request, within 10 business days:
- The service provider’s licence number.
- The name of anyone currently authorized by the service provider, to provide goods or services in connection with listed expenses on its behalf.
- The registration number on the certificate of registration, issued to a regulated health professional by their regulatory college.
- The name of anyone who used to be authorized by the service provider, to provide goods or services in connection with listed expenses on its behalf in the past.
- The time period for which the aforementioned individuals used to be authorized, to provide goods or services in connection with listed expenses on the service provider's behalf.
Access to claimant personal health information
Section 46.2 of the SABS permits an insurer to request any information it requires to determine its liability for payment, which may include claimant personal health information.
However, the SABS requires the insurer to act reasonably and request only the information necessary to determine its liability for payment. This provision does not grant an insurer blanket access to all clinical records, and/or notes related to a particular claimant. In making such requests, insurers should ensure that the claimant has provided the proper consent.
By FSRA Senior Compliance Officers when they conduct on-site examinations
To ensure that service providers are in compliance with their licence obligations and meeting the specific requirements of Ontario Regulation 90/14, FSRA Senior Compliance Officers (SCOs) must have access to the service provider’s completed claims forms submitted through HCAI (OCF-18, OCF-23 and OCF-21).
The potential disclosure of any personal health information during the course of an examination is for the lawful purpose of conducting a compliance examination, authorized under section 443(1) of the Insurance Act (Ontario).
It should be noted that, during the examination, the compliance items FSRA examiners are looking for generally do not require the review of the portions of the forms that might contain personal health information. In addition, FSRA SCOs are not collecting, recording or removing this information from the premises. The exception may be where an SCO believes there is fraudulent activity, and that the forms contain false or inflated information about an individual’s injuries.
Like all Ontario Public Service employees, FSRA SCOs must, pursuant to the Public Service of Ontario Act take an oath of office, and swear and affirm that they will not disclose or share any information or document that comes into their knowledge or possession except as required by law.
Schedule for reviewing business records
Every service provider licensee must conduct periodic reviews of the forms, plans, invoices and any other documents submitted to insurers to ensure the licensed service provider complies with the legislation and its billings.
Depending on the size of the business, the review must be as frequent as:
Every three months
Service providers paid $50,000 or more in listed expenses under the SABS in the calendar year prior to the review.
Every 12 months
Service providers paid less than $50,000 in listed expenses under the SABS in the calendar year prior to the review.
Need more help?
If you have more questions about how to stay compliant as the holder of a service provider licence, please contact FSRA by email at [email protected].