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ICBC - Physiotherapy

ICBC has launched some exciting updates for billing Physiotherapy claims after April 1, 2019.

This guide covers several topics all in one document. It may appear a bit dense, but don’t worry! If you’ve experienced portal billing in Jane before, it’s very similar and once you run a few claims through you’ll get the hang of it. Our team are also ready to help the first time! So feel free to give us a call to walk through a claim submission together if you’d like the moral support.

To get a feel for how portal billing works in general you can watch this quick video about launching the external portal in Jane (the video shows Blue Cross, but will be the same for ICBC once the portal becomes available).

Here we’ll cover:

  • Creating an Insurer
  • Creating Custom Billing Codes
  • Creating a Claim
  • Transitioning Existing ICBC claims/patients
  • Insuring the Appointment
  • Managing the Insurer Invoices
  • Reconciling Payment

If you’re familiar with any of these steps just scroll through to the next one!

You’ll be managing your claims manually through the HCPIR portal as ICBC no longer supports the billing of these claims through MSP/Teleplan, but as of April 1, 2019 each treatment is billed using one set amount rather than up to four separate billing codes.

If you’re new to billing Physiotherapy services to ICBC, you’ll first want to ensure that you have a Vendor Number. If you’re unsure whether or not you have a Vendor Number, you’ll want to contact ICBC. You can do so through their feedback form here.

Create an Insurer

If you’ve been previously billing your ICBC claims through Teleplan, you will want to leave your existing ICBC (Teleplan) insurer as is in the event that you need to bill for claims pertaining to crashes that happened prior to April 1, 2019. Further down this page are some more specific instructions for transitioning current claims.

In order to track and manage claims on or after April 1, 2019, you’ll need to set up a new ICBC insurer. Insurers can be created by heading to Settings > Insurers > New Insurer 

You’re going to choose the option Regular Insurance/3rd Party Payer/Lawyer because you won’t be submitting these claims via Teleplan.

You can call it something like “ICBC - Physio”, and set the insurer’s default behaviour. If your fee schedule is higher per subsequent visit than what ICBC pays, you may choose to set either a user fee or set the insurer to default patient pays remaining so that the amount of the treatment not covered by ICBC is absorbed by the patient.

You may also find it helpful to include the link to the HCPIR portal in the field for Portal URL.

The URL you’ll want to use is https://webapps.icbc.com/ClaimsForms/

You can review this help document for more details on setting up an insurer.

If your clinic is a multi-disciplinary practice, it is recommended that you set up an ICBC insurer for each discipline. So, for example if you offer both Physiotherapy and Massage Therapy, you would have one insurer for ICBC - Physio and one for ICBC - Massage. Each discipline does have a preauthorized number of treatments available and for patients seeking treatment with more than one discipline at the same clinic, it will be easier to keep track of the visit counts if each discipline is represented by a separate claim.

Create Custom Billing Codes

All though ICBC claims will no longer be submitted through Teleplan, ICBC has outlined that there is still a specific fee amount associated with a patient’s initial visit/report and a separate fee amount for each treatment thereafter.

  • Initial Visit & Report: $250
  • Subsequent Visits: $79 per treatment
  • Number of Preauthorized Treatments: 25

ICBC notes that:

“ICBC customers (patients) who choose to visit a health care practitioner that charges a higher rate than what ICBC funds under accident benefits (indicated above), will not be able to recover the user fees from ICBC for claims with a date of loss on or after April 1, 2019. This will mean that the patient is responsible for paying the user fee portion, which they may submit to their private health insurer for consideration of coverage. Treatments are based on sessions provided and fees reflect fair market rate for a standard industry visit. Treatment frequency will be based on clinical recommendations and should reflect best practice. However, multiple sessions provided by the same discipline, on the same day, will not be funded.”

If your private rates for a Subsequent Visit are lower than the rates as outlined by ICBC, you’ll bill the ICBC rate ($79) not your regular private rate.

To populate the above fee amounts in a patient’s claim, you’ll want to create custom billing codes for both of the fee items.

Custom billing codes can be created by heading to Settings > Billing Codes > New Billing Code

So like this :

Create a Claim

Once you have the insurer and custom billing codes created, you’re ready to begin building patient claims.

From the appointment pane, choose Add Claim and then Add New Claim/Policy.

Choose ICBC - Physio from the list, and then continue to populate information into the claim template.

The only required field is the Claim Identification Number, which will be the patient’s ICBC claim number.

You’ll add the relevant maximums to the optional middle section. This section is where you’ll want to enter Maximum Number of Treatments as being 25 so that Jane will alert you when the amount/value has been reached.

Lastly, enter any Default Coverage Amounts that will be populated each time the claim is used - setting defaults can help save time for subsequent appointments that are billed the same each time.

It is recommended that here you enter the billing code that you’ve created to represent the fee amount billed for a subsequent treatment. You will need to override the billing code used on a patient’s first visit to be the billing code that represents the fee amount billed for the initial visit & report, however this step will only need to be done once per patient claim.

For more tips on creating a claim click here.

Transitioning Existing ICBC Physiotherapy Claims

To transition your existing Physiotherapy claims, on or after April 1, 2019 you’ll want to create a new claim for each active ICBC patient using the ICBC - Physio insurer for non-Teleplan claims. It is recommended that you use the Claim Name field to indicate that the claim is effective April 1, 2019. If you have pre-booked appointments, with old claims attached, you will need to remove those claims and replace them with the newly created one.

When setting up the new claims, if the patient has an end date, or a pre-authorized number of treatments available, you’ll want to indicate those maximums in the new claim. For example : you have a patient that has 8 approved sessions left with an end date of May 31, 2019, you’ll want to set the Maximum Number of Treatments for the new claim at 8, and set the end date for May 31, 2019.

If services prior to April 1, 2019 still need to be billed and submitted, you will do so using the previous fee per service and those claims will be submitted through Teleplan. Teleplan will continue to accept ICBC Physiotherapy claims for 18 Months after April 1, 2019 to allow for services prior to April 1, 2019 to be billed retroactively, and as well to allow rejected claims to be resolved and resubmitted.

Insure the Appointment

After saving the claim, you’ll now find the claim attached to the appointment under the “Insurer Info” section on the righthand side of your page.

You no longer require a diagnostic code for every billing code. A patient’s diagnosis and any applicable clinical information will now be communicated to ICBC through the HCPIR web-based forms.

If all looks good with the claim, Arrive the appointment. From there, if the patient is due to pay a portion, you can proceed with collecting that payment using the Pay button

Managing the Insurer Invoice

ICBC claims for all disciplines are now managed like any other claim submitted through a portal. How you choose to manage the frequency in which claims are submitted is up to you. You may wish to submit each claim after the treatment has occurred, or you may find that it works better to let claims build up in your Unsubmitted folder and submit a bunch of claims at the same time.

If you prefer to submit each claim as or after the treatment is happening, if you’ve added the link to the HCPIR form to the “Portal URL” field of your ICBC insurer, then you can launch the report from the Claim Screen.

From the Schedule click on the appointment to open the appointment pane to the right.

At the top of your page, below the patient’s name there is the insurer name in blue.

When you click on the blue words ICBC - Physio you will launch the claim window including a link to the report:

If you are submitting the Initial Visit you will need to attach the completed Physiotherapy Initial Report. This link is a sample of the report - an actual fillable PDF version will be released on April 1st. The fillable form will need to be completed and saved to your computer and then uploaded within the portal.

After submitting the claim to ICBC, mark the invoice as submitted via the drop-down arrow next to its name:

This updates its state from Unsubmitted to Submitted.

You can also manage paper claims from Billing > Unsubmitted.

In the “Unsubmitted” folder, click the drop-down arrow next to an item line to Mark as Submitted, and it’ll subsequently move to the “Submitted” folder.

Now you wait for payment.

Reconciling Payment

It is our understanding that payments for ICBC claims will be directly deposited into the bank account used when enrolling for EFT (Electronic Fund Transfer)

When you receive confirmation from ICBC that payment has been received, you can record the payments in Jane using the New Payment workflow. If you’re unfamiliar with this workflow, please visit the guide document below.

Receiving an Insurer Payment

For the full breakdown of ICBC’s guidelines on invoicing and reporting for Physiotherapy, you can visit their website here.

And for some handy videos and guides from ICBC that review how to submit invoices, reports, extensions and discharge notifications through the HCPIR portal click here

Extension Requests are completed right in the portal (no fillable PDF download/upload required) and should be completed at least 2 weeks prior to the end of the 12 week pre-approved period, or well before the end of the pre-approved 25 visits. Click on the blue link right above to see all of this in action in ICBC’s videos. They’re helpful!

You can always email us at support@janeapp.com or give us a call at +1-844-310-5263 if you have further questions, or if you’d like to walk through the setup of this with a member of our team.