Document name
Chiropractors
Document number
PRO 54/2016

Effective date: June 1, 2016

Application: All claims where workers require chiropractic services.

Policy subject: Health care services – Providers

Purpose:

To provide administrative guidelines for approving and evaluating chiropractic services.

BACKGROUND

Policy section content
Section detail
  1. Upon Workers’ Compensation Board (WCB) approval, a worker entitled to benefits under The Workers’ Compensation Act, 2013 is also entitled to (Section 103):
    1. Any medical aid that may be necessary because of the work-related injury.
    2. Any other treatment by a health care provider.
    3. Any orthotic appliance that may be necessary as a result of the injury, and
    4. Any travel and sustenance costs associated with receiving medical treatment as a result of the injury.
  2. The WCB is authorized to determine health care service fees (Section 104).

PROCEDURE

Policy section content
Section detail
  1. Chiropractors who are members in good standing of the Chiropractors’ Association of Saskatchewan (CAS) and accredited by the WCB to provide services to injured workers can access the following at www.wcbsask.com:
    1. Accreditation Standards and Service Provider Guidelines for Chiropractors Providing Services to Saskatchewan WCB Customers.
    2. Accreditation requirements.
    3. Primary Chiropractic and Physical Therapy Soft Tissue Treatment Guidelines.
    4. Primary Care Provider Review process.
    5. Fees.
    6. Reporting forms, and
    7. Primary Authorization to Treat forms.

The CAS and WCB will negotiate changes to these documents as needed.

  1. The WCB Chiropractic Consultant will review files that have two or more progress reports (CHP) if the worker is not discharged or sent for an assessment team review. However, Claims Entitlement Specialists (CES) and Case Managers (CM) can request the assistance of the WCB Chiropractic Consultant at any time during the review of claims.
  2. Medical and Health Care Services (MHCS) will contact chiropractors (by phone and in writing) that continually send initial reports (CHI) or progress/discharge reports (CHP) late to the WCB. MHCS will issue a final warning if the late reporting continues. Thereafter, the WCB will not pay for services that chiropractors provide after reports are due.
  3. The WCB will only reimburse functional conditioning treatment for workers after they have been unable to return to regular or modified work duties for at least four consecutive weeks. If the worker needs functional conditioning before then, the chiropractor will contact the WCB. The WCB Chiropractic Consultant will review the worker’s progress before making a decision.
  4. For all soft tissue injuries, the CM will review the worker’s file at seven weeks post-injury to:
    1. Evaluate the risk of prolonged recovery.
    2. Determine if the worker needs an assessment team review.
    3. Ensure vocational (return-to-work) interventions are occurring, and
    4. Ensure that the chiropractor is using the WCB’s standards of care and treatment protocols.
  5. If the WCB denies a chiropractic claim for coverage (following the initial assessment or request for further treatments), the WCB will pay for services up to the date of notification.
  6. Chiropractors must contact the WCB Chiropractic Consultant before providing services in excess of that noted in the soft tissue guidelines. If no contact is made, the WCB may not pay the excess fees.

Policy references

Policy reference content

Section heading

Act Sec #

Page/document title
55, 103(1), 104, 115(c)

Section heading

Supersedes

Page/document title
PRO 56/2013 Medical Fees – Chiropractors

Section heading

Complements

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