Physical 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 be accredited by the WCB.
To apply for accreditation with the WCB:
Make sure all documentation is included and fax it to the WCB. 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.
Your physiotherapy license includes a direct access provision, which means you can treat customers without referral by a licensed provider.
However, within three days of commencing treatment, you need to send a Physiotherapist’s Initial Report (PTI) form to the WCB detailing your initial findings. We will contact you if funding cannot be granted and will pay for services to the date of that advice. See the PTI User Manual.
To prevent financial hardship to a WCB customer, bill the WCB directly for approved services. To direct bill, you will need the WCB billing number you or your clinic 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 we will fund treatment for a customer by submitting a Physiotherapist’s Initial Report (PTI) to the WCB according to the standards of care for your profession. Unless the WCB discontinues funding, you may treat up to 10 sessions.
Summarize all services provided during the billing period using the Physiotherapist’s Billing (PHYS) form.
Follow the fee schedule agreed to by your professional association.
Forward the completed Physiotherapist’s Billing (PHYS) form to 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) in this case 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|
To ensure that WCB Practice Standards for Care for Physical Therapists are being followed, compliance surveys may be conducted. Treatment centres, clinics and individual practitioners will be notified two weeks before they are to be surveyed and can prepare for the survey by reviewing the survey form and guidelines in advance. Surveys take approximately 1.5 hours and will be conducted by WCB representatives.
When an injury claim has been disallowed or benefits terminated, physical therapists will be notified that the WCB cannot pay for further assessment or treatment. We will only pay for treatment for which authorization was given to the date of notice of termination. We will also pay reporting fees to the date of notice.
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 provincial legislation, care providers do not require a signed release from an injured worker in order to provide medical information to the WCB because:
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 the WCB as quickly as possible. We cannot pay for illegible or incomplete reports.
Only the customer’s FOM score should be submitted to the WCB, not the form itself. The score is to be reported on the Physiotherapist’s Initial Report below.
Physiotherapists report after every 10 treatments using the forms listed above. Failure to report can seriously delay an injured worker’s claims process and may result in delays or non-payment to the provider.
The WCB pays reporting fees when the care provider invoices the appropriate fee. If more than one report is received in the same day, only one report fee is paid.
There is a two-tier fee for PTI and PTP reports: one for reports that include FOM scores and a lower fee for those that do not include the scores.
The WCB has a “View client information” application available for primary level chiropractors and physical therapists to use through their WCB online account. This application provides you with the ability to easily view medical documents online for an injured worker that you are treating. As soon as a new report comes in for your claim, you will automatically be able to view it.
The “View client information” application will allow you to see medical reports from other care providers, as well as referrals the WCB is making to specialists, diagnostics, assessment teams, etc. Assessment team reports do not appear on the “View client information” application as the assessment team will send a copy of the summary report to all current providers and a copy of the complete report to the primary care provider and surgeon.
You must have a WCB online account to view medical documents online for injured workers you are treating. You must have an online report submitted before the “View client information” application will be available to you. You also must complete online reporting regularly to use “View client information”.
For soft tissue injuries, refer to the Primary Chiropractic and Physical Therapy Soft Tissue Treatment Guidelines.
Return to work should generally be part of each worker’s 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:
When treating WCB customers, physical therapists will:
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