For physicians
After treating an injured worker, you can bill WCB-Alberta for your services as outlined in the WCB fee schedule, provided you have followed the terms and conditions of the WCB/AMA Agreement. Service fees are based on the current Alberta Health Schedule of Medical Benefits (SOMB).
Unbundling
When billing WCB for services, you are entitled to a separate, unbundled fee, payable at 100 per cent, for each distinct part of the procedure. For example, Alberta Health Rules prohibit billing SOMB Code 92.8D (debridement of knee) with SOMB Code 92.32B (knee arthroscopy).
Unbundling does not apply when one part of a procedure, in keeping with best medical practices, is required in order to complete another. In those cases, the different procedures are considered linked and the usual Alberta Health Rules apply.
Denied claims
If you provide services for a worker whose claim status is later changed or modified, WCB may attempt to recover some or all of the payments made and instruct the provider to recover those costs from Alberta Health or another non-WCB payor.
Within 90 days of receiving the claim denial notification, you can submit your invoice to Alberta Health for payment. The 180-day limit will be waived for denied claims.
If WCB has paid you for services on a denied claim, we may recover the costs against future payments owed to you. WCB will not seek recovery of:
- Payments made for medical aid and reporting for a first visit.
- Payments made for expedited services and associated reporting.
- Payments made for any other reports, including associated costs.
If WCB seeks recovery of the costs associated with medical aid, you may bill Alberta Health in accordance with the Master Agreement and the AH Schedule of Medical Benefits. WCB will limit its recovery to the amount payable by Alberta Health. When requested, you must provide a copy of the Alberta Health billing record when reimbursing WCB.
Surgical assist and anesthetic services claims
When submitting claims for ANEST (time-based) or a surgical assist where several procedures were done at the same time, please use the code for one of the procedures performed to submit the total time of the surgical assist. Listing all of the services separately can mistakenly lead to double payments and subsequent over-payment recovery.
For all contracted providers
Direct deposit
With direct deposit, payments can be deposited directly into a designated chequing, savings or deposit account at any Canadian financial institution. This voluntary service, available to all health care providers who bill WCB for claimant-related services, is provided at no charge.
You will receive a payment advice statement from WCB for any payments processed by direct deposit. These are normally mailed on Monday (or Tuesday, if Monday is a holiday) and the payment is usually deposited on Wednesday (or Thursday, if Monday is a holiday).
Billing number
- All billing numbers must be identified on the direct deposit request form for payment to be directly deposited.
- If a clinic bills WCB on behalf of the health care provider, the clinic's billing number must be listed on the form.
- If payments are issued to individual providers at the location, the billing number and banking information for each practitioner must be provided on separate forms.
If an error or over-payment has occurred, please call our contact centre. Have all applicable information (claim number, payee, date of service, etc.) ready to ensure we can help you as quickly as possible.
