The Workplace Safety and Insurance Board (WSIB) will pay a professional home care service visit where someone is entitled to benefits under the Workplace Safety and Insurance Act and a physician has ordered the home care services for the work-related injury/illness. The WSIB relies on a Community Care Access Centre (CCAC) to manage and organize the appropriate home care treatment for the worker injured or ill person.
Homemaking services and meal preparation will be paid if they are part of a program that includes one or more professional services (e.g., physiotherapy, nursing care, etc.).
Effective June 4, 2001
Fees are billed for the actual visit to the injured or ill person’s home and are not based on the length of time spent per visit. Up to a maximum of four visits per day is considered reasonable if required to meet the person’s needs.
|Home care services (per visit)||Service code||Fee|
|Personal support worker/Homemaker||9003||$25.86|
|Speech language therapy||9007||$25.86|
|Assistant: Occupational therapy/Physiotherapy/Rehabilitation||9008||$25.86|
The WSIB does not pay for cancelled or missed appointments.
Billing of fees
As stated in Section 33 (5) of the Workplace Safety and Insurance Act, “No health care practitioner shall request a worker to pay for health care or any related service provided under the insurance plan.”
Under Section 33 (4) of the Workplace Safety and Insurance Act, the WSIB may impose a percentage reduction penalty for late submissions of accounts. Accounts received after the 6th month from the date of service may be reduced in the following manner:
- 7th – 9th month reduced by 25%
- 10th – 12th month reduced by 50%
- over 1 year reduced by 100%
The WSIB may waive the late penalty charge if an acceptable reason for the delay is provided.
Community Care Access Centres (CCAC) : Questions & Answers
What is the current Workplace Safety and Insurance Board (WSIB) fee for Community Care Access Centres (CCAC)?
Effective June 4, 2001 the fee is $25.86 per visit. Services provided prior to June 4, 2001 will be paid at $25.28 per visit.
Is the $25.86 per visit, per provider or per day?
The WSIB will pay $25.86 for each professional service visit where someone is entitled to benefits under the Workplace Safety and Insurance Act and a physician has ordered the home care services.
Will the WSIB pay for homemaking services and/or meal preparation?
The WSIB will pay for homemaking services/ meal preparation if they are part of a program that includes one or more professional services (e.g. physiotherapy, nurse care, etc.).
Does this mean that there could be a daily visit for homemaking with a weekly visit for physiotherapy?
Daily homemaking is appropriate in acute cases where the injured or ill person requires physiotherapy and/or nursing care as part of the program.
However, in cases where the professional service is, for example, social work or speech therapy, homemaking would not be appropriate.
Is the $25.86 per visit fee based on an average length of time for the visit (e.g. an hourly rate)?
Under the $25.86 per visit fee structure, is there a maximum number of visits allowed per day?
Up to a maximum of four visits per day is considered reasonable if required to meet the person’s needs. The WSIB relies on the CCAC to manage and organize the appropriate treatment.
Can the CCAC be compensated for past claims?
If you believe that your account was not assessed and paid correctly, contact the WSIB.
Can the CCAC bill for ancillary services, such as rental of equipment?
No. These services are included in the $25.86 per visit fee.
Will the WSIB pay the CCAC for completion of reports?
There is no separate fee for completing reports. Payment for completion of reports is included in the $25.86 per visit fee.
How does the CCAC find a someone's WSIB claim number?
Contact the WSIB for this information. To help expedite your inquiry, you should provide as much information as possible, such as the claimant’s name, birth date, date of accident, Social Insurance Number and/or the name of their employer.
Provider Payment Request form (3947A)
For prompt payment, complete as follows:
- Claim Number: enter WSIB claim number; this is necessary to process the payment.
- Name: print surname, given name(s), and middle initial.
- Worker’s Impairment and/or ICD 9 Code: enter diagnosis or ICD 9 code for which treatment is being provided.
- Date of Accident: enter reported date of accident.
- Address: enter current mailing address.
- Date of Birth: enter birth date.
- WSIB Reference No.: please do not complete. For WSIB use only.
- Provider/Facility Name and Full Address: enter name and full address of the provider/ facility submitting the bill.
- WSIB Provider ID: enter your invoice number. (Your reference no. for reconciliation purposes.)
- Your Own Invoice No.: enter your invoice number. (Your reference no. for reconciliation purposes.)
- Treating Provider’s Name: enter the name of the individual providing the service.
- Treating Provider’s ID No.: this is the individual health professional’s number that WSIB assigns to you.
- Telephone Number: provide the telephone number of the individual completing the payment request form.
- Service Code: enter appropriate service code. Refer to the WSIB Fee Schedule.
- Description of Service/Treatment: provide a brief description of service or type of treatment provided.
- Fee per Service: enter fee per treatment or service from the WSIB Fee Schedule.
- No. of Serv./Trt.: enter the number of services/ treatments that you are billing.
- Amount Billed: enter the total amount for the one service code.
- Service Date: enter month and year. Select date(s) of service by (n). For multiple months, use a separate line.
- Total Billed: enter the total sum of fees billed.
- Name: enter the name of the individual completing the form.
- Signature and Date: include the signature of the individual completing the payment request form, and date, when form is completed.
For electronic billing, contact the Telus Health Solutions, Support Centre at 1-866-240-7492 or via e-mail at firstname.lastname@example.org.