Community treatments

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.

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.

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.

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.