By discipline: Nurse Practitioner
To apply for accreditation:
- Read the WCB Nurse Practitioner Accreditation Standards and Service Provider Guidelines carefully.
- Complete the Accreditation Request – Primary Level Services form, print and sign it.
- Attach evidence of:
- Your educational credentials.
- Current licensure with your licensing body.
- Additional educational credentials if you are applying for aerobic assessment and treatment accreditation.
Make sure all documentation is included and fax to us. Please note that we cannot process incomplete applications.
- Review your credentials against the requirements listed in the WCB Nurse Practitioner Accreditation Standards and Service Provider Guidelines.
- Add your name to our Approved Providers List, if you are eligible.
- Notify you by mail that your accreditation request has been accepted or rejected.
- Mail you a billing number.
Accreditation is Not Transferable
We will accredit you for work in all the clinics you list on your application. You must submit a separate accreditation request if you add a clinic to your portfolio or if a clinic changes location. We cannot issue payment for care at a clinic where the provider is not accredited prior to that care being provided.
Your Nurse Practitioner license includes a direct access provision. This means you can treat our customers without referral by a licensed provider. However, within three days of beginning treatment, you need to send in a Primary Practitioner’s Initial Report (PPI) form detailing your initial findings. We will contact you if funding cannot be granted and will pay for services to the date of that advice.
You may refer our customers to other care providers. Referrals must identify the medical limitations and goals and objectives of treatment. Please note that referrals do not constitute authorization to treat. The providers must contact us for authorization to treat the referred customers on a file-by-file basis.
Please bill us directly for services provided. To direct bill, you require a WCB billing number. We will issue your billing number once your accreditation application has been approved. We will not pay for treatment provided prior to your accreditation date or for treatment provided at a clinic for which you have not been accredited.
- Invoice us for services provided to our customers using the Doctor’s Billing (DOC) form or reasonable facsimile, following the Saskatchewan Medical Services Branch (MSB) payment schedule and assessment rules;
- Payments for non-MSB insured services and reporting fees are established by us in negotiation with professional associations. Non-MSB service fees are included in the fee schedule; and
- We do not have a reciprocal billing process with MSB. Invoices sent incorrectly to either insurer will be returned for resubmission.
- List all services and service dates on the Doctor’s Billing (DOC) form.
- Follow the fee schedule agreed to by your professional association.
Payment can only be issued if the invoice meets the criteria. The following information is required:
- Worker’s name
- Worker’s address
- Provincial health number
- Date of birth
- Date(s) of service
- Care provider number
- Clinic numberNurse
- Practitioner’s name
- Nurse Practitioner’s address
- Nurse Practitioner’s phone and fax number
- Fee code(s)
- Fee code amount(s)
- Number of units
Retain your daily record of the service you provide to our customers in case an audit is required.
The WCB will not pay any account rendered by a physician, surgeon, hospital or other health care professional or institution for medical aid service if application for payment is received by Operations or Medical Accounts after twelve-month period from the time the medical aid is administered to an injured worker. See Procedure PRO53/2006.
We will notify you when an injury claim is disallowed or benefits are terminated. If we deny a worker’s claim after you provide services, we will only pay for non-MSB fees submitted prior to the date of notification of disallowance. We will not pay MSB and treatment fees.
Under provincial legislation, you do not need a signed release from our customer to provide medical information to us. Early and regular reports are important to our customer and to us because:
- We require customer medical records to process claims and appeals.
- We may need to provide copies of reports to other health care providers, such as assessment teams, treatment centres and specialists to help to get the best possible assessments and treatments for our customers.
You should advise our customers that their medical records may be made available to their employers or others if their claims are appealed.
Use the following forms to provide information about treatment, functional recovery, and response to treatment. Please fill out reports completely and legibly and fax them to us as quickly as possible. We cannot pay for illegible or incomplete reports.
- Primary Practitioner’s Initial Report
You are required to submit a Primary Practitioner’s Initial Report (PPI) for all injuries, including those that do not result in time off work. Where our customer loses time from work because of an injury, the PPI provides confirmation of disability. This allows us to arrange timely payment of benefits to our customers, and to prevent financial hardship for our customer.
- Progress and Discharge Reports
A Physician’s Progress Report (PPP) should be completed every three weeks or if the customer’s condition changes. If the worker has been discharged, the PPP should be completed within three days.
- Return to Work Report
Once a return-to-work plan has been agreed upon, please work directly with the employer and the worker regarding hours of work and restrictions for that week. Restrictions should be given to the worker at the first office visit and updated as necessary in subsequent visits so that modifications can be established with employer as soon as possible.
- Other Reports
Copies of special reports – diagnostic, operative, and so on – should always be forwarded to us. They provide us with relevant information, and save the attending practitioner from preparing a separate report.
Reporting Schedule – Nurse Practitioners report after every three weeks or earlier if the worker’s condition changes using the forms listed above. Failure to report can seriously delay our customer’s claims process and may result in delays or non-payment to the provider.
Reporting fees are paid by us when invoices use the appropriate fee. If more than one report is received in the same day, only one report fee is paid.
You assume certain roles and responsibilities when treating our customers. You must ensure that:
- All workplace injuries requiring medical aid are reported promptly.
- All treatment is necessary and consistent with established agreements.
- All invoices are appropriate.
- The employer and worker are aware of current restrictions to allow early return to work.
When treating our customers, we ask that you:
- Familiarize yourself with the contents of the WCB Nurse Practitioner Accreditation Standards and Service Provider Guidelines.
- Comply with the standards and fee schedule established by us with your professional group and all requirements of your licensing body.
- Demonstrate ethical practice standards on a day-to-day basis, including disclosure to any prospective WCB customer of any business relationship you may have with their employer. This allows the worker to make an informed decision regarding their choice of care provider.
- Refrain from using your affiliation with us in any advertising for your services.