Navigating WCB Alberta: A Guide to Billing for Functional Capacity Evaluations

Billing the Workers’ Compensation Board (WCB) Alberta for a Functional Capacity Evaluation (FCE) involves specific procedures and forms. Here's a comprehensive guide detailing the referral process, billing methods, and information on preferred vendors.

Billing WCB Alberta for an FCE

1. Types of FCEs

• Basic Functional Capacity Evaluation (BFCE): A half-day assessment conducted early in the claim process to determine baseline abilities and the need for treatment.(WCB Alberta)

• Comprehensive Functional Capacity Evaluation (CFCE): A two-day assessment performed later in the claim to evaluate sustainable work abilities and outline any restrictions. (WCB Alberta)

2. Billing Procedures

• Contracted Providers: If you're a contracted provider with WCB Alberta, billing is typically processed through the Electronic Claims Organization (eCO) system. Ensure you have a valid WCB billing number (e.g., X999).(WCB Alberta)

• Non-Contracted Providers: For non-contracted providers, prior approval is required. You must agree to submit regular reports and invoice at WCB rates. Without authorization, WCB will not be responsible for payment. (WCB Alberta)

Referral Process for FCEs

1. Initiation of Referral

• Medical Status Examination (MSE): Typically, an FCE is completed after a Medical Status Examination, which assesses the worker's current medical condition and work restrictions. (WCB Alberta)

Referral Sources: Referrals for FCEs can be initiated by:

• Treating physiciansWCB Alberta

• Community health care providersOxford Academic+5WCB Alberta+5WCB Alberta+5

• EmployersBack Active+5WCB Alberta+5WCB Alberta+5

• WCB decision makersLeading Edge Physio+5WCB Alberta+5WCB Alberta+5

In some cases, WCB departments such as Medical Services or Millard Health may facilitate referrals. WCB Alberta+1WCB Alberta+1

2. Referral Forms and Procedures

• Return-to-Work Referral (FM733): This form is used to initiate the referral process for assessments like FCEs.

• Specialist Clearance Letter (SP235H): If the worker is under the care of a community specialist, this letter is sent to obtain a written release of care before proceeding with the referral. (WCB Alberta)

• Out-of-Province Referrals: For workers residing outside Alberta, select "Out of Province" in the provider drop-down box in eCO, and a task is sent to the Health Care Strategy (HCS) Out of Province Referral Team Desk. (WCB Alberta)

Preferred Vendors and Facilities

• Millard Health: WCB Alberta's own facility offering various assessment services, including FCEs.

• Contracted Providers: WCB maintains a network of contracted providers across Alberta. Whenever possible, workers should be referred to these providers.(WCB Alberta)

• Non-Contracted Providers: If no contracted provider is available in the worker's area, non-contracted providers may be considered, provided they agree to WCB's terms and receive prior approval. (WCB Alberta)

Additional Resources

• WCB Alberta Forms and Guides: Access various forms required for billing and referrals. (WCB Alberta)(WCB Alberta)

• WCB Alberta Procedures Manual: Detailed procedures for medical testing, referrals, and program support. (WCB Alberta)(WCB Alberta)

• Millard Health Assessment Services: Information on assessment services provided by Millard Health. (WCB Alberta)(WCB Alberta)