If you offer Physiotherapy in BC, here’s how you can manage your billing for ICBC claims in Jane.
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.
- Creating an Insurer
- Creating Custom Billing Codes
- Creating a New Policy
- Insuring the Appointment
- Managing the Insurer Invoice
- Reconciling Payment
- Additional Notes
Creating an Insurer
The first step in creating a claim is creating the insurer. To do this, ensure you are logged into an account with at least Administrative Staff/All Billing Access permissions.
For more information on the different access levels and permissions in Jane, check out our guide doc on Staff Access Levels.
To start, you’ll want to head over to the Settings tab and in the menu on the left, scroll down and select Insurers. Next, you can click on the New Insurer button in the top right corner:
From here, you’ll want to make sure to select the Regular Insurance/3rd Party Payer/Lawyer option.
You can call it something like “ICBC - Physiotherapy”, and set the insurer’s default behaviour. If your fee schedule is higher per 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 the Portal URL. The URL you’ll want to use is https://webapps.icbc.com/ClaimsForms/
For more information on Insurers in Jane, you can head over to our setting up an insurer guide for more details.
Note 📝: 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 Kinesiology and Physiotherapy, you would have one insurer for ICBC - Kinesiology and one for ICBC - Physiotherapy. 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.
Creating Custom Billing Codes
ICBC has outlined that there is a specific fee amount associated with a patient’s assessment visit and a separate fee amount for each treatment thereafter. These fees apply for visits on or after April 1, 2024 for complete and most up-to-date information see ICBC’s Fee Guide for Health Care Providers.
- Initial Assessment Visit: $147 per treatment
- Standard Treatment: $93 per treatment
- Number of Preauthorized Treatments: 25
- Progress Report: $128 per report
- Range of Motion Report: $90
- Scarring Measurement Report: $45
- Care Plan Meeting: $15/5 min increments
The preauthorized treatments are available within 12 weeks of the date of the accident causing the injury.
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 ($93) and 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.
To get started with creating these custom billing codes, a staff member with Administrative/ All Billing access or higher can head over to the Settings tab, click on Billing Codes within the left menu and click on New Billing Code in the top right.
Here’s what the fields would look like:
Creating a New Policy
Once you have the insurer and custom billing codes created, you’re ready to start creating policies for your clients. Within the Appointment Panel, you’ll scroll down to the Insurance Info section, click on Add Policy and then select Add New Policy.
Next, select the insurer you’ve created from the list.
On the next page that opens up, the only required field is the Claim Identification Number, which will be the patient’s ICBC claim number.
Scroll down a bit further on the page, you can add the relevant maximums to the optional middle section. This section is where you’ll want to enter the Maximum Number of Treatments as being 25 so that Jane will alert you when the amount/value has been reached.
ICBC also allows for extensions on coverage if required. The requests for extensions are to be made through ICBC’s HCPIR portal and it is recommended that if you determine an extension is required, you apply for it no later than 2 weeks prior to the end date of the patient’s claim.
This allows for the claim handler to process the request before the patient’s coverage expires. If coverage has expired and an extension has not yet been approved, you won’t be able to submit further claims until the extension is approved.
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.
Note📝 : It’s 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.
Once that’s filled out, you’ll want to scroll to the bottom and click the blue Save button to confirm those changes.
For more details on this process, you can check out our Creating a Patient Policy(CA) guide.
Insuring the Appointment
After saving the policy, you’ll find it attached to the appointment under the Insurance Info section within the Appointment Panel.
You do not 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.
To override the billing code from Subsequent Visit to the code for an Assessment Visit, you can select the black dropdown arrow and select Change Billing Code. This only needs to be done on the patient’s first visit.
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
If you prefer to submit each claim as or after the treatment is happening, and you’ve added the link to the HCPIR form to the “Portal URL” field of your ICBC insurer, you can launch the portal from the policy 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, you’ll see the insurer’s name in blue text.
Clicking on the blue text will launch the policy window, including a link to the portal where you can submit invoices and any applicable reports:
After submitting the claim on ICBC’s portal, make sure to mark the invoice as Submitted using the black dropdown arrow next to the claim:
Pro-tip 💡: Did you know you can also manage your claims by also heading over to the Billing tab and then selecting the Unsubmitted folder? From there, you’ll want to click on the black dropdown arrow next to an item line and select Mark as Submitted. The claim is then automatically moved over to the Submitted folder.
Now you wait for payment.
Note 📝: If you are working with fillable PDF forms that you have downloaded from the ICBC website and would like Jane to help give you a bit of a head start filling out some of the fields, check out our guide on Fillable Forms for more information!
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) for your Vendor Number.
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, you can check out our guide doc on Receiving an Insurer Payment which has more detailed information.
Additional Notes
For the full breakdown of ICBC’s guidelines on invoicing and reporting for Physiotherapy you can visit their website here.
You can always email us at [email protected] 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.