Occupational therapists must apply for accreditation with the WCB. Learn about accreditation, authorization to treat, billing, payments, reporting to the WCB and what forms you need.
Before you can provide services to WCB customers and bill the WCB directly for those services, you must first be accredited by the WCB.
To apply for accreditation with the WCB:
Make sure all documentation is included. Note: The WCB cannot process incomplete applications.
Our health care services department will review your application after receiving it. We will:
You can only bill for services from all the clinics you listed on your application. If you want to add a clinic to your portfolio or if a clinic changes location, you must submit a separate accreditation request for that clinic before you begin treating customers there. We cannot issue payment for care at a clinic where the provider is not accredited prior to that care being provided.
You must get approval from the WCB to treat WCB customers. Don’t rely on customers for authorization because they may think their claim number means the WCB has agreed to pay for their treatment.
To get approval, you need a referral by a licensed practitioner (physician, chiropractor or physiotherapist) who identifies the medical limitations, goals and objectives of treatment.
You also need a signed Primary Authorization to Treat form from the customer’s case manager. If you don’t get approval before treating, we may not pay for your services.
If a claim is later denied following approval for treatment, we will be responsible for payment for services to that date.
To prevent financial hardship to a WCB customer, bill the WCB directly for approved services. To direct bill, you or your clinic requires a WCB billing number, which you received when your accreditation application was approved. The WCB 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.
You are responsible for confirming in advance that the WCB will fund treatment for a customer according to the standards of care for your profession. Do not rely on the customer for this information, because they may confuse their receipt of a claim number with a commitment by us to pay for their treatment.
Summarize all services provided during the billing period using the Physiotherapist’s billing form (PHYS).
Follow the fee schedule agreed to by your professional association and the WCB;
Payment can only be issued if the invoice meets our criteria. The following information is required:
* Follow the guidelines for the billing period
If the WCB receives an application for payment after a 12-month period from the time the medical aid is provided to an injured worker, the WCB will not pay any account rendered by a physician, surgeon, hospital or other health care professional or institution. See WCB procedure, Medical Aid Billings – Payment (PRO 53/2006).
Keep a daily record of the service you provide to our customers in case an audit is required.
If you have submitted an invoice that does not have the correct amount of units (too many/not enough), an adjustment/addition needs to be made to your original invoice.
Write “Adjustment/addition” on the top right-hand corner of your invoice.
To make an adjustment to a fee code that was already paid, the WCB needs to reverse the number of units you indicated on the original invoice, then reissue the correct amount of units. To do this:
See a billing adjustment example.
If you use your WCB online account to retrieve your original invoice:
By submitting WCB invoices online, they will be processed through an automatic payment process. This means your invoices will be paid sooner than if you fax or email them to us.
Online submission methods:
Save time and give your users the ability to upload invoices online.
Eliminate entry duplication by uploading invoices from your system to the WCB website. Here is the document with instructions on how to update your software: Everything a vendor needs to know.
Here are the files needed for updating your system to be compatible with the medical invoice batch submission process:
If you have any questions with the batch submission process or are ready to test your system with us, please contact the webmaster.
Vendors who are already capable of uploading batch invoices:
|Accuro/QHR Techologies||CBS Navicert Software|
The WCB issues payments to care providers weekly and provides statements to confirm the payments were issued. These statements may include explanatory codes to provide details regarding specific services.
Care providers, like employers and workers, are required to report to the WCB any work-related injury that requires medical attention, whether or not the worker needs time off work beyond the day of the injury. Prompt reporting allows the WCB to arrange timely payment of benefits to injured workers.
Under legislation, care providers do not require a signed release from an injured worker in order to provide medical information to the WCB because:
The occupational therapist (OT) forms are coded forms to be used to provide information about treatment, functional recovery and response to treatment.
Please complete the OT forms legibly and fax them to us as quickly as possible.
When treating WCB customers, care providers assume certain roles and responsibilities. The WCB relies on all care providers to ensure that:
When treating WCB customers, occupational therapists will:
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