Nurse practitioners

To be a WCB accredited Nurse Practitioner (NP), NPs must hold current licensure with the College of Registered Nurses of Saskatchewan (CRNS) as a NP.

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 treatment.

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.

Doctor’s Billing (DOC) form

To prevent financial hardship to a WCB customer, bill the WCB directly for approved services. To direct bill, you require 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.

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.

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 and the WCB.

Payment can only be issued if the invoice meets our criteria. The following information is required:

• worker’s name
• worker’s address
• Provincial Health Number (PHN)
• date of birth
• date(s) of service
• care provider number
• clinic number
• nurse practitioner’s name
• nurse practitioner’s address
• nurse practitioner’s phone and fax number
• fee code(s)
• fee code amount(s)
• number of units

If the WCB receives an application for payment after a 12-month period from the time the medical aid is provided to a 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.

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:

1. Single submission:  Submit an individual invoice related to a worker.
2. Batch submission: If you use Accuro/QHR Technologies or CBS Navicert software to keep track of your medical records, you can submit a batch of invoices to the WCB online. As long as you have the access to submit invoices online, you can submit all invoices from any time period and from any care provider at the same time.

You will need a WCB online account to submit invoices online.  Sign into your WCB online account or, if you don’t have one, create a WCB online account here.

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:

1.    eBillBatchInvoice.xsd
2.    ebillBatchInvoiceReturn.xsd
3.    Batch Submission – Error Codes.xlsx

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

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-Saskatchewan Medical Services Branch (MSB) fees submitted prior to the date of notification of disallowance. We will not pay MSB and treatment fees.

You are encouraged to register for a secure WCB online account, which allows you to view medical documents and payment statements.

We issue payments to care providers weekly and provide statements to confirm the payments were issued. These statements may include explanatory codes to provide details regarding specific services.

Submit a direct deposit application to avoid delays in your WCB payments by receiving your payments by electronic transfer.

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 workers.

Legislative obligations

Under legislation, care providers do not require a signed release from a worker in order to provide medical information to the WCB because:

• WCB staff need customers’ medical records to process claims and appeals.
• The WCB may need to provide copies of reports to other care providers, such as assessment teams, treatment centres and specialists, to assist in obtaining the best possible assessments and treatments for workers.
• In the case of an appeal, a worker’s records may be made available to an employer or others, but only with the worker’s approval.
   

Forms

Nurse practitioners 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 a worker 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.
• 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 the employer as soon as possible.
• Other reports
  Copies of special reports – diagnostic, operative, and so on – should always be forwarded to the WCB. They provide 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.

If a worker’s recovery does not progress, you may ask the WCB to arrange for a secondary treatment or expedited appointments, if required.

Return to work should generally be part of each treatment plan. For more information, see our recovery and return to work page.

When treating WCB customers, care providers assume certain roles and responsibilities. The WCB relies on all care providers to ensure that:

• All work-related injuries requiring medical aid are reported promptly.
• All treatment is necessary and consistent with established agreements.
• All invoices accurately reflect the services provided.
• The employer and worker are aware of current restrictions to allow early return to work.

When treating our customers, nurse practitioners will:

• Know and follow the contents of the WCB Nurse Practitioner Accreditation Standards and Service Provider Guidelines.
• Bill the WCB in accordance with the fee schedule established for 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..
• Avoid mentioning in either your clinic’s advertisements or personal advertisements that you treat WCB customers or you are affiliated with the WCB in any way.

For more information, please refer to our Support Package for Physicians & Nurse Practitioners.