With so many new features, functions and tools that have made your clinic management a breeze in 2019, this has been one busy year at Antibex! One popular example is our release of WSIB integration with Universal Office earlier this year, allowing claims to now be submitted directly to WSIB straight from Universal Office. (In case you missed it, check it out Now Integrated with Universal Office: WSIB eServices! and 3 Reasons Why To Submit WSIB Claims in Universal Office)
So how is TELUS Health WSIB eServices different than eClaims? Here are four big differences between these two very important systems:
1. Purpose
Both TELUS Health eClaims and WSIB eServices streamline the approach to billing, allowing patients to focus on their health and service cost submitted on their behalf – but they differ in purpose.
eClaims facilitates the claim submission process for Extended Health Care (Group Benefits claims to TELUS Health participating insurers, check out the participating insurers).
WSIB, on the other hand, facilitates the process of claim submissions that are the result of a workplace accident to the Workers Safety Insurance Board.
2. Claim Submission Period
With eClaims, claims are to be submitted within 31 days from the date the services were incurred. However, claims should be submitted while the patient is in your office at the time the service is provided. Once a claim is submitted, the claim is adjudicated immediately, and a copy of this adjudication must be provided to your patient.
With WSIB eServices, Program of Care claims are electronically submitted at the end of the corresponding period, or whenever the patient is discharged. Fee for Service claims are submitted at the required timeline, as advised by WSIB electronically or alternatively via fax or mail. Neither WSIB claims that are submitted electronically or manually are adjudicated immediately – unlike eClaims. Upon receipt of the claim, WSIB reviews and adjudicates the claim accordingly and a determination response will be sent by way of mail or available online to service providers who have registered for online billing with WSIB.
3. Authorization Forms
Prior authorization for treatment services is not required for extended healthcare benefits unless otherwise specified as per one’s plan. There may be additional documents that need to be provided for claim adjudication and to be in compliance with policy specifications (such as doctor referrals).
Unlike WSIB claims that have clear processes set forth when an employee is injured at work, as outlined below:
- Accident must be reported to the client’s employer.
- The employer completes an incident report.
- The injured employee seeks medical attention.
- The injured employee reports their injury to their family doctor, who will complete a Form 8 (Physician’s First Report).
- All of the above documents are submitted to WSIB and client seeks appropriate treatment.
- Treating facility assesses injury, determines an appropriate treatment plan (like under a Program Care) and submits Initial Assessment Report to WSIB within two working days.
- Treating facility communicates treatment with WSIB and provides protocols and requirements in accordance with WSIB.
4. Mandatory vs. Optional
Facilities that have signed up for Programs of Care must submit claims electronically as per their signed agreement between themselves and WSIB. However, it is not mandatory that Fee for Service claims be submitted electronically. In contrast, submitting via eClaims remains completely optional. That is a significant difference.
Do you know any additional differences between TELUS and WSIB that we didn’t cover in this article? If so, please let us know in the comments below.
And as always, keep checking back to our blog for the latest in industry news!
