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Community treatments - Archived Apr 7, 2025

Procedure summary

Published On

Oct 25, 2022
Purpose

This procedure guides the decision maker through the process of reviewing and accepting the treatment, monitoring the progress of their recovery, and extending treatment as necessary.  

Description

The decision maker refers to the person assigned to manage the claim and make decisions at certain points in the claim. The decision maker has access to other resources for support in the decision-making process, including supervisors and internal consultants within the WCB.

The request for community treatment is reviewed to ensure it’s appropriate for the worker’s injury and will contribute to their recovery and return to work.

Specialized treatments and/or treatment from non-contracted treatment providers require appropriate approval. The decision maker discusses options with the worker and together they decide the best course of action and strives to remove any barriers that may prevent the worker from attending their appointment.

The decision maker maintains regular communication with the worker and the provider and monitors the progress of the worker’s recovery and extends treatment as required.

Key information

Treatment including physiotherapy, chiropractic and acupuncture can be beneficial to workers by providing an active functional exercise approach to their treatment and recovery. It also educates workers about pain management strategies and how to manage their daily activities to prevent re-injury.

Treatment providers may be contracted or non-contracted. Non-contracted providers include any who are not contracted with WCB to provide services, including private, hospital facility, and out of province. The process for determining entitlement for treatment is different for contracted and non-contracted providers.

The method for authorizing treatment also differs depending on claim circumstances and can be found under the individual treatment sections.

Detailed business procedure

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1. Review the treatment request and determine if treatment is related to the work injury

Review the provider’s initial assessment and first treatment report with the worker’s entitlement information and injury details. Is the proposed treatment for the compensable injury?

Note: It is important for claim owners to review treatment reporting as soon as possible to ensure there are no delays in care.

When the relationship between the injury and treatment is not clear, discuss with the worker, treatment provider or the appropriate internal consultant.

Administrative tasks

Refer to the individual treatment sections for updating eCO and sending letters.

2. Determine if the treatment provider is contracted with WCB and document the treatment decision

When treatment can be approved, authorize the standard timeframe specific to the treatment. The approval process is different for contracted and non-contracted providers and is also determined by the treatment type.

The decision maker’s approval is required when the worker requests to receive treatment from a non-contracted or out of province provider. Treatment in Alberta hospitals does not require approval.

Contracted provider

For contracted physiotherapy and chiropractic providers, the initial report is received through RapidReportRapidReport is the electronic injury reporting system that is used by employers and providers. and auto-entitlement applies or is sent through an exception benefit approval task. This excludes contracted acupuncture providers, which is updated manually.

Note:

When the treatment notification is not processed as an auto-entitlement or sent through an exception benefit approval task, document the treatment and decision by adding the authorized treatment line and completing the Benefit Details tab with the required payment information.

Non-contracted provider

The initial treatment report from a non-contracted treatment provider is not received through RapidReport. Auto-entitlement does not apply.

The decision maker manually approves treatment when the provider is,

  • hospital based
  • out of province

Note: Non-contracted treatment from private community treatment clinics in Alberta requires Health Care Services approval.

Administrative tasks

Refer to the individual treatment sections for updating eCO and sending letters.

When processed through auto-entitlement, eCO automatically:

  • Adds the Authorized Treatment line (if not previously added),
  • Updates the benefit details tab with the dates and amount authorized and sets the status to approved,
  • Sends a treatment plan update email to the provider and provider is notified of approval through RapidReport
  • Generates a task to send the authorization decision letter to the worker and employer.

After the Benefit Details screen is updated, eCO automatically,

  • Adds the treatment line,
  • Advises the provider of the decision through RapidReport
  • Sends a letter task to the claim owner based on the decision

When the report is received by email or fax, eCO prompts the decision maker to manually determine treatment entitlement by generating:

  • New mail task
  • Update the authorized treatment line and benefit details tab.

Complete the (FM957A) Health care services Out of Province Referral form to locate physiotherapy services out of province.

3. Communicate the decision

The decision maker determines the appropriate authorization process.

When treatment is approved and auto-entitlement applies, the provider is notified through RapidReport.RapidReport is the electronic injury reporting system that is used by employers and providers. Send the appropriate decision letter, including the date range for the treatment, to the worker with a copy to the employer.

If auto-entitlement doesn’t apply to an approved treatment request, the provider is not notified through RapidReport. Send the appropriate approval letter to the treatment provider with copies to the worker and employer.

When the treatment is not related to the work injury or is pending further review, contact the provider and the worker to discuss. Send the appropriate letter with a copy to the worker and employer.

Administrative tasks

Refer to the individual treatment sections to update eCO and send the appropriate decision letter.

Send the appropriate approval letter from the CL048 series to the worker with copy to the employer. Refer to the individual treatment sections for the specific letter.

4. Authorize medical benefits and other expenses

Authorize the medical benefits, travel and any other related expense. Send the appropriate travel and expense forms.

Administrative tasks

Send the Travel and Expense Record (C-688) form to approve travel or mileage.

Send the Wage Loss (C-394) form if the worker is missing work to attend treatment.

Add the appropriate lines and update the related benefit details tab, if required.

5. Monitor progress and maintain regular contact

Maintain regular contact with the worker, employer, and provider, as required, to discuss the worker's recovery progress, goals and attendance to ensure the care plan is on track.

Ensure the provider has a detailed description of the pre-accident job and any modified work that may be available.

Administrative tasks

Document the conversations in a file note and attach to the Authorized Treatment line.

6. Review requests for extension of treatment and determine entitlement

Review the treatment provider’s request for extension.

Questions to Consider:

  • Is the worker making progress?
    • Are work hours or duties progressing?
    • Do reports demonstrate their functional abilities are improving?
  • What is the goal for the treatment extension?
  • Does the extension support treatment goals?
  • Is the length of the extension reasonable to achieve outlined goals?

Review extension requests as soon as possible to ensure there are no delays in care.

Authorize the extension when it is appropriate and ensure there are no concerns about the worker’s progress in treatment.

If there are questions or concerns about the worker's recovery or the additional treatment, contact the provider to get further information, and discuss if an alternate care plan would be more beneficial.

Use available resources to conclude treatment or consider a referral for other assessments/services when appropriate. If there are questions about the best plan of action, consider forwarding the referral to a WCB internal consultant (physiotherapy or chiropractor consultant) for an opinion.

Review and action the internal consultant recommendations.

Contact the worker to discuss the additional treatment, including any recommendations from the internal consultant. Discuss the recommendation with the provider if an alternate plan is recommended.

Note: A request for one or two transitional return-to-work visits (immediately following discharge and scheduled over a three-week period) is not considered an extension request.

Administrative tasks

Contracted providers that meet the auto-entitlement criteria are notified of the treatment extension decision through RapidReport.

For questions, submit a referral to or call the appropriate internal physiotherapy or chiropractor consultant directly.

Add a file note (Physiotherapy, Case Conference) to document conference calls with the provider.

Refer to the individual treatment sections to update the treatment extension decision in eCO and send the appropriate decision letter.

Types of community treatment

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Acupuncture

Acupuncture is an alternative form of treatment and can be performed stand-alone by a registered acupuncturist or it may be performed by a physical therapist, chiropractor, or physician certified to practice acupuncture by their respective regulatory college.

Documenting initial treatment approval

When treatment is approved, update the approval manually and send the appropriate decision letter.

Authorize up to seven acupuncture treatments over a four-week period, including the combined assessment and first treatment.

Treatment extension requests

Forward the recommendation to a physiotherapy consultant when there is a request to extend treatment beyond the standard initial number of treatments. Include the progress report the provider submitted after the first five visits, detailing the worker’s status, objective findings and the number of additional treatments requested.

Administrative tasks

Complete the eCO benefit approval task when the Acupuncture's First Report (M-007) (M-007P) is received, and the auto-entitlement criteria is not met.

Update the benefit details screen. Add the total cost for the entire authorized treatment period into the maximum total field ($791.64, up to a total of six weeks).

Send the Approval for Acupuncture Treatment (SP014A) letter to the provider outlining the details of the authorization. Send a copy to the worker and employer.

Add a file note (Physiotherapy, Case Conference) to document conference calls with the provider.

Send the appropriate letter to the provider, including rationale, when treatment is pending or denied:

  • Authorization is Pending for Acupuncture Treatment (SP014B) letter
  • Send the Denial of Acupuncture Treatment (SP014C) letter

Send a copy to the worker and employer.

Review the Acupuncture Progress Report (M-007A) to determine the progress of the worker’s recovery.

Add or update the authorized treatment line and benefit details tab.

Chiropractic

Chiropractic treatment places a major emphasis on active exercise as it relates to the worker’s physical job demands. It combines specific adjustment and manipulation techniques. It can be performed as a stand-alone treatment or can be combined with physiotherapy and/or acupuncture.

Documenting initial treatment approval

When treatment is approved, update the approval and send the appropriate decision letter.

Authorize up to 22 treatments over six-weeks, including the combined assessment and first treatment.

Approval to use a non-contracted provider

Non-contracted chiropractors must inform the worker that WCB will not be responsible for payment, either to the chiropractor or the worker, nor can the chiropractor bill Alberta Health. Non-authorized clinics must submit a payment waiver form to the WCB with the non-authorized chiropractor treatment report.

Verify the non-contracted Alberta providers service rates (excludes hospitals) and contact the health care consultant to obtain approval.

All chiropractors at an authorized clinic are considered authorized providers.

Documenting the initial treatment

Notify the treatment provider of the decision. Send the appropriate decision letter to the worker with a copy to the employer. Include the date range of the treatment authorized.

Document the decision in the authorized treatment line and benefit details tab.

Send the appropriate decision letter to the treatment provider and a copy to the worker or employer outlining the date range of treatment and advising that extension requests must be pre-authorized.

Note: Without authorization, WCB will not be responsible for payment to either a non-contracted chiropractor or the worker, nor can Alberta Health be billed.

Review and document approval for extension

Review the treatment extension request from the provider and supporting medical information on the file. Confirm the request supports the worker’s recovery and progress.

Consider:

  • Has the worker been making progress?
  • What is the goal of the extended treatment?
  • Does the extension support the treatment goals?
  • Is the end date for the extension reasonable to achieve outlined goals?

Authorize the extension when it is appropriate and there are no questions about the worker’s progress or care plan. Send the appropriate letter.

Contact the provider for further information and to discuss whether an alternate care plan is advised when there are questions or concerns about the progress of the worker’s recovery or treatment, or the request for extension is pending or denied.

Consider other available resources, such as internal consultant referral or further assessment before the decision is made to extend treatment.

Administrative tasks

Complete the eCO tasks when the Chiropractor's First Report (C-056) is received, and the auto-entitlement criteria is not met.

The full dollar amounts for maximum treatment is $791.64 for a six-week period.

Auto-Entitlement:

eCO automatically updates the authorized treatment line and benefit details tab. Notify the provider of the decision.

Approval through Benefit Exception Task:

eCO automatically updates the authorized treatment line and benefit details tab.
Notify the provider of the decision.

Send the Chiropractic Treatment Authorization (CL048B) letter to the worker with a copy to employer.

Non-contracted:

Add the Authorized Treatment line (if not already added), Update the Benefit Details tab with information related to the treatment.

Request an opinion from a chiropractic consultant when there are questions about treatment or to determine if approval can be obtained for a non-contracted provider.

Document the details of the discussion. Add a file note (Chiropractic, Details) to document conference calls with the provider.

Send the appropriate letter to the provider, including rationale, when treatment is pending or denied:

  • Authorization Pending for Chiro Treatment SP016C letter
  • Denial Chiro treatment (SP016D) letter

Send a copy to the worker and employer.

Request the treatment report in writing when it has not been submitted with a payment waiver form from a non-contracted chiropractor, in accordance with Section 34 of the Worker’s Compensation Act.

Review the Chiropractor's Progress/Discharge (C-532) Report to determine the progress of the worker’s recovery and when there is a request for extension.

Send a referral to the internal consultant requesting an opinion on whether the treatment extension is reasonable. Document the conversation in file note.

Send the Approval for Chiro Treatment Extension (SP016B) letter to the chiropractor when treatment is extended. Send copies to the worker and employer.

Physiotherapy (PT)

Physiotherapy may be performed in a physiotherapist clinic, community health centre or as part of a hospital-based program. Whether contracted or non-contracted, the authorized provider follows the contract standard for treatment and reporting.

Authorize up to a maximum of 12 treatments over four consecutive weeks, including the combined assessment and first treatment for standard injuries.

Injuries with a specific protocol, such as a fracture or post-surgery, have a separate service period.

Soft tissue injuries and fractures not under protocol

The treatment for these types of injury has a two-phased authorization and is up to a maximum of 16 treatments over six consecutive weeks.

Phase one: Initial authorization

  • Is up to 12 treatments over four consecutive weeks.
  • Includes the date of assessment and first treatment.
  • Is individualized to meet treatment goals.

Phase two: Review the treating physiotherapist’s progress report and recommendation, which may include:

  • To extend an additional four treatments over two weeks to achieve a return-to-work outcome.
  • The final two weeks of treatment in phase two are payable at the standard rate.

If treatment is recommended beyond nine weeks for soft tissue injuries or a second extension is requested for surgical/fracture protocol injuries, and the request supports the worker’s recovery and return to work, refer the request to the physiotherapy consultant for review.

Note: If further extension is required, refer to a physiotherapy consultant for review and opinion.

Approval for non-contracted provider

Send the referral to a physiotherapy consultant for an opinion on clinical appropriateness.

Verify the non-contracted Alberta Providers service rates (excludes hospitals) and contact the Health Care Consultant to obtain approval.

When authorized to treat an individual worker, non-contracted physiotherapy clinics and hospital physiotherapy clinics/community health centres should follow the contract standard for treatment and reporting.

Regional hospitals

Treatment can be approved by the decision maker and paid at the provider's standard rates.

Out-of-province providers (OOP) and referral:

Treatment can be approved by the claim owner and paid at the provider's standard rates.

The physiotherapy consultant will review all reports received directly to the physiotherapy consultant fax line. The physiotherapy consultant will fax authorization to the treatment team noting time frames for treatment and when to submit reporting.

Documenting initial treatment

When the report is received from the RapidReportRapidReport is the electronic injury reporting system that is used by employers and providers. system, the treatment provider is notified of the decision through RapidReport. Send the appropriate decision letter to the worker with a copy to the employer. Include the date range of the treatment authorized.

Document the decision in the authorized treatment line and benefit details tab.

Send the appropriate decision letter to the treatment provider and a copy to the worker or employer outlining the date range of treatment and advising that extension requests must be pre-authorized. All extensions for hospital physiotherapy require authorization by the physiotherapy consultant.

Note: A request for one or two transitional return-to-work visits (immediately following discharge and scheduled over a three-week period) is not considered an extension request.

Administrative tasks

Auto-Entitlement:

eCO automatically updates the authorized treatment line and benefit details tab.

The full dollar amounts for maximum treatment is $947.00 for a four-week period.

Add a file note (Physiotherapy, Case Conference) to document conference calls with the provider.

The provider is notified of the decision through RapidReport.

Approval through Benefit Exception Task:

eCO automatically updates the authorized treatment line and benefit details tab.

Send a PT Treatment Authorization (CL048A) letter to worker with a copy to employer.

Non-contracted:

Add the Authorized Treatment line (if not already added). Update the Benefit Details tab with information related to the treatment.

Send the Approval for PT treatment (SP015A) letter.

Send the appropriate letter to the provider and the worker when treatment is not approved or is pending:

  • Denial for PT Treatment (SP015D) letter
  • Authorization Pending for PT Treatment (SP015C) letter

Create a referral to the Physiotherapy Consultant, Team Desk to review the hospital provider’s report and fax the authorization time frame and reporting time frame expectations.

Hospital Hand Clinic Assessment Report (C-829)

Hospital Occupational Therapy Assessment Report (C-826)

Forward requests to extend treatment to the physiotherapy consultant for review when it is for a soft tissue injury beyond nine weeks and/or a second extension for surgical/fracture protocol injury.

Specialized physiotherapy

Once physiotherapy treatments are authorized, specialized physiotherapy can be delivered by a contracted physiotherapist and may be performed during extended duration visits. This treatment option requires decision maker approval.

Specialized physiotherapy includes:

  • vestibular assessmentAn assessment completed by a physiotherapist with specialized training to confirm diagnosis and treatment when a worker presents with symptoms of dizziness.  An assessment completed by a physiotherapist with specialized training to confirm a diagnosis and treatment when a worker presents with symptoms of dizziness.and treatment
  • in-home physiotherapy
  • one-on-one pool therapy
  • post-surgical hand assessment and treatment delivered by a certified hand therapist
  • internal pelvic floor therapy

A worker may be authorized to receive extended duration visits when they meet the criteria: Multiple, distinct, compensable injuries to separate body parts or require a specialized treatment.

Extended duration visits combine specialized physiotherapy with standard physiotherapy treatment in short durations. Such as combining vestibular treatment for dizziness from a concussion and regular physiotherapy to treat a neck strain.

Determine whether the request meets criteria and effectively supports the worker’s recovery. Approve up to seven extended duration visits verbally or in writing. Maintain and document all communication with the treating physiotherapist.

Approval for non-contracted provider

When a quote is received from a non-contracted provider who is quoting costs above the contracted rates, forward the referral to the physiotherapy consultant for authorization. Document the decision.

Review and document approval for extension

Forward all extension requests beyond the initial set limit to the physiotherapy consultant for review and authorization.

Administrative tasks

Send a task or file note to the Physiotherapy Consultant, Team Desk, or call the physiotherapy consultant directly.

Supporting references

Policies

  • 04-02, Part I, Temporary Benefits
  • 04-06, Part I, Health Care

Workers’ Compensation Act

Applicable sections

  • Sections 34 (1) (2) (3)
  • Sections 78 (1) (2) (3) - Provision of medical aid

General Regulation

Applicable sections

Related Legislation

Applicable sections

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