Ontario’s Workplace Safety and Insurance Board (WSIB) pays physicians the cost of services billed for healthcare and any related services covered under the Workplace Safety and Insurance Act. In this blog, we share the process of billing your WSIB Ontario Claims and how we can help make the process easier.
WSIB Billing Process
When a patient comes in for a WSIB visit, there are two steps that a physician must go through. The following chart provides a visual representation of the WSIB billing process that occurs for every WSIB visit.
Step 1: Submit WSIB Ontario Forms
In the first step, the physician must complete the WSIB Ontario forms provided by the patient and submit them to WSIB either digitally or by fax. After two weeks, WSIB pays the service codes by cheque or direct deposit.
Since WSIB payments cannot be tracked through your EMR, Telus has developed a solution to streamline the WSIB payment process.
To track the status of the forms submitted through fax or digital, you can create an account through this link. Once you get your temporary account and password, you can log into the portal here and set up your permanent password.
After completion, you will be able to submit your forms digitally and bill WSIB visit codes through the portal.
Please note: the WSIB Ontario form does not need to be completed if the patient comes in about a work-related injury where a form was not created. In this case, the physician would skip the first step and go to step 2. The visit would be submitted as an A007 or A001 with WSIB as the insurer.
Most Common WSIB Ontario Forms
The following WSIB Ontario forms are the most common used by physicians. These are the only two forms under WSIB that are valued differently depending on the method of submission.
To view the full list of WSIB Ontario forms, read the Physician Fee Schedule here.
Health Professional’s Report (Form 8)
The Health Professional’s Report is filled out by the physician following the initial visit where a worker has been treated for a workplace injury/illness. The form can be submitted only once for each worker and the report must not be used as a progress report.
Health Professional’s Progress Report (Form 26)
The Health Professional’s Progress Report is sent from WSIB to the patient when a progress report is required. The physician must complete the form for the patient and submit it to the WSIB.
How to Submit Your WSIB Ontario Forms
As mentioned previously, the WSIB Ontario forms can be submitted by fax or digitally. We do recommend submitting Forms 8 and 26 digitally as it is an easy process and physicians receive a higher value versus fax. If you would like to submit your form digitally, you can get started by signing up for an account on TELUS Health WSIB eServices here as mentioned in Step 1.
Step 2: Bill Visit to OHIP
In the second step, the physician would bill the visit to OHIP like any other visit. However, in addition to the physician billing the appropriate code, they would need to indicate WSIB as an insurer for that visit. The visit is then submitted to OHIP and is paid through the OHIP deposit within 1-3 months.
Like all other billing, you can go back into your billing records to reconcile, correct, and resubmit any WSIB billing visits. If your claims have been submitted through your EMR, you can reconcile your claims in your RA.
Note: When a claim is created in your EMR, you must change your claim provider from the default HCP to WCB.
A reminder that WSIB form codes cannot be submitted through your EMR in combination with visit codes A007/A001. Claims that look like this (ex. A007 + M640) in a single claim will not be processed for payment.
Instead, A007/A001 will need to be submitted in a separate claim and billed to insurer WCB to be reconciled in your EMR and reflected in your RA. For tracking and reference purposes, a claim can be created with the WSIB form code.
Let us take WSIB billing off your plate!
We are now offering WSIB Billing support to all physicians with our Billing Care and Billing Care Plus services. In addition to providing financial reporting and transparency, we will:
- Generate routine batch submissions to OHIP, including WSIB bills
- Track, follow up, and ensure payment of claims to OHIP
- Provide detailed monthly reporting of OHIP bills paid
- Reconcile and resubmit any errors for OHIP and WSIB claims
As an added service, we can also help you with your WSIB Ontario claims by offering support by phone/email for any WSIB-related inquiries.
