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:
- Read the Practice Standards for Primary Occupational Therapy Service Providers.
- Complete, print and sign the Accreditation Request – Primary Level Services form.
- Attach copies of your educational credentials.
- Attach a copy of your current membership registration with your professional association.
- Fax your accreditation package to the WCB’s health care services department to the fax number on the form.
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:
- Review your credentials against the requirements listed in the Practice Standards for Primary Occupational Therapy Service Providers.
- Add your name to our approved providers list, if you are eligible.
- Notify you by mail that your accreditation request has been accepted or denied.
- Mail your WCB billing number to you.
Accreditation is non-transferable
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:
- worker’s name
- worker’s address
- Provincial Health Number (PHN)
- date of birth
- billing period*
- care provider number
- clinic number
- occupational therapist’s name
- occupational therapist’s address
- occupational therapist’s phone and fax number
- fee code(s)
- fee code amount(s)
- number of units
* Follow the guidelines for the billing period
- 1st of the month to the end of the month (i.e. Jan. 1 – Jan. 31/20).
- 1st of the month to the 15th of the month (i.e. Jan. 1 – Jan. 15/20).
- 16th of the month to end of the month (i.e. Jan. 16 – Jan. 31/20).
- Always use 1st of the month regardless of holidays and weekends.
- Please maintain consistency with the method you choose.
- If the primary start date is within the billing period, then the beginning of the billing period should be the primary start date.
- i.e. primary start date is March 3/20, billing period is then March 3/20 to March 16/20, or March 3/20 to March 31/20, depending upon the billing period chosen from the above examples.
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.
How to make an adjustment/addition to an invoice:
Write “Adjustment/addition” on the top right-hand corner of your invoice.
Adjustment (amending a fee code that has already been paid)
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:
- Print off original invoice that needs adjusting.
- Bracket the fee code, number of units and extended total for each line you want reversed.
- To show your adjustment, at the bottom of your invoice indicate the fee code, the new number of units, and the new total for each fee code you want paid.
- Provide the new invoice total.
See a billing adjustment example.
Addition (for a fee code that has not been billed on your original bill)
- Print off the original invoice that needs adjusting.
- To show your addition, at the bottom of your invoice indicate the new fee code, the number of units, and the new total you want paid.
- Provide the new invoice total.
Email the adjustment/addition to the WCB to email@example.com or fax it to 1.888.844.7773.
If you use your WCB online account to retrieve your original invoice:
- Log in to your WCB online account.
- Click on “Medical invoices”.
- Click on “Review forms”.
- Find the form you need to adjust.
- Click on the “edit” icon.
- The worker’s information will be displayed. Scroll to the bottom and click “Next”.
- Invoice details will be displayed. Scroll to the bottom and click “Next”.
- Injury details will be displayed. Scroll to the bottom and click “Review”.
- Your invoice will appear.
- Follow the instructions above to manually make adjustments/additions.
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:
- 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 injured 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.
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:
- 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 an early return to work.
When treating WCB customers, occupational therapists will:
- Know and follow the Practice Standards for Primary Occupational Therapy Service Providers.
- Follow the fee schedule established for your professional group.
- Show ethical practice standards on a day-to-day basis. This includes informing any prospective WCB customer of business relationships you may have with their employer, so the worker can decide whether they want to choose you as a 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.