Effective date: October 1, 2011
Application: All claims on and after the effective date.
Policy subject: Health care services – providers
To establish the billing requirements for dental services provided to Workers’ Compensation Board (WCB) customers.
- Section 103(1) of The Workers’ Compensation Act, 2013 (the “Act”) states “every worker who is entitled to compensation or who is disabled only on the day of the injury is entitled without charge to:
- any medical aid that may be necessary as a result of the injury;
- any other treatment by a health care professional;
- any prosthetics or apparatus that may be necessary as a result of the injury, and to have any prosthetic limbs and eyes and any surgical appliances such as belts, braces, supports and orthopaedic shoes repaired, maintained and renewed when necessary by reason of accident or ordinary wear and tear; and
- any transportation or sustenance occasioned by the medical aid.”
- Section 104(1) of the Act states “the fees for medical aid furnished by any health care professional are those that are determined by the board.”
- Section 115(c) of the Act states that the board may expend moneys from the fund for any expenses incurred in the administration of the Act and, without restricting the generality of the foregoing, the board may expend money for “any medical aid provided pursuant to this Act to injured workers and any specialized treatment or other medical aid that the board considers necessary and that is not provided for in this Act.”
- Annually, the College of Dental Surgeons of Saskatchewan issues a suggested fee schedule to its members.
- Dentists and dental surgeons will direct bill the WCB for all services provided to WCB customers and will charge according to the College of Dental Surgeons of Saskatchewan Fee Schedule. Payment for all dental services will comply with this fee schedule.
- All dental services, except emergency treatment, must be pre-authorized by the WCB.
- The dentist or dental surgeon will submit a Dentist’s Initial Report (M7) to the WCB indicating the type of service required, and a cost estimate based on the fee schedule.
- Operations staff will review the report to ensure that the recommended service is related to the work injury, and the estimated costs are in accordance with the fee schedule. Assistance may be obtained from the WCB Dental Consultant.
- Where the recommended service is not noted in the fee schedule, the WCB Dental Consultant may provide advice regarding a reasonable fee that should be paid.
- Following this review, Operations staff will authorize the dentist or dental surgeon, in writing, to proceed with the service. The authorization will request the dentist or dental surgeon to direct bill the WCB for the service and amount authorized. A copy of the authorization will be sent to the customer.
- Operations staff will provide a detailed explanation, in writing, in all instances where the amount authorized is less than the cost estimate provided by the dentist or dental surgeon.
- Where the customer obtains emergency treatment, the dentist or dental surgeon will submit a Dentist’s Initial Report (M7) to the WCB. Following review of the report by Operations staff, and by the WCB Dental Consultant where required, the WCB will process payment (if authorized) to the dentist or dental surgeon.
- Where the customer paid the fees for the emergency treatment, the customer should submit to the WCB, copies of original receipts and the form completed by the dentist or dental surgeon detailing the work completed. Original receipts must be retained for 12 months from submission date, as they may be requested by the WCB for audit purposes.
- Where the fee is in excess of that determined by the WCB, the WCB will contact the dentist or dental surgeon and request a refund for the customer. Where a refund is not provided, the WCB will reimburse the customer and the extra billing will be recovered from WCB payments to the dental service provider.
PRO 03/91 Medical Fees – Dental Consultant
01 January 2014. References updated in accordance with The Workers’ Compensation Act, 2013
01 November 2017. Requirement for original receipts updated to copies of original receipts; however, original receipts must be retained for 12 months from submission date, as they may be requested by the WCB for audit purposes.