In May of this year, WorkSafeBC will be launching a new Claims Management Solutions (CMS)—electronic adjudication—system designed to improve services to injured workers, health care providers, and employers. As WorkSafeBC receives claim information from an injured worker, employer, and physician, the new system will electronically field and gather the data, automatically adjudicate the claim, and, in most cases, pay worker benefits and health care provider billings.
The CMS system allows WorkSafeBC to insert an anticipated return-to-work date on the injured worker’s claim file for use by internal staff. Research shows that patients with common conditions, such as back pain or asthma, who are off work for as little as 12 weeks, are up to 50% likelier to never re-enter the workforce. The attendant medical, social, family, and financial impacts associated with prolonged unemployment and disability affect both patient morbidity and mortality. The anticipated return-to-work date will alert internal staff to address the possibility that your patient may be in a population at risk for permanent withdrawal from the workplace. WorkSafeBC staff will view the alert as an urgent trigger to assist you and your patient with resources aimed at restoring the individual to a fully functioning state, including his or her return to work.
System requires minimal changes
Regarding your injured-worker patients, the information you send to WorkSafeBC and your invoicing process essentially stays the same. Most changes to the process are internal to WorkSafeBC.
To ensure you and your injured-worker patients take maximum advantage of the new adjudication system, please remember to do the following:
• Use the new barcoded forms—all forms will be filed into the system by barcode. Please download and use the barcoded forms 8 and 11 that are already available in the forms section of the Health Care Providers pages of the WorkSafeBC web site, www.WorkSafeBC.com. As soon as the new system is operating, use of the barcodes on the new forms will be essential.
• Use appropriate ICD-9 diagnosis codes—medical and payment information in the new system is based on ICD-9 diagnoses, and, therefore, entering a correct code on the file is more important than ever. Prior to the May launch of the system, we will provide you with a table outlining the key ICD-9 codes for the injured-worker diagnoses you are most likely to encounter.
• Send only information that is relevant to your patient’s WorkSafeBC claim—your injured-worker patients have always been able to obtain the information on their claim file, including the medical information you send in. However, alongside our new system, we will be opening a worker portal, so injured workers can have timely online access to their claim file. We anticipate that the ease of viewing claim files will mean more injured workers will be reading medical reports on their claim files.
As always, medical information contained in your injured-worker patients’ claim file should be relevant to their WorkSafeBC claim. Sometimes files document sensitive biopsychosocial information that presents the possibility your patient could face prolonged disability, and this information should still be provided, if relevant. However, irrelevant medical information should never be sent to us to place on a worker’s claim file. We will vet all medical documents (except form 8), but ask that you always consider the relevancy of information sent to WorkSafeBC. If you have questions or concerns, please do not hesitate to contact us.
Implementing the new system
For up to 4 weeks in May while we are making the transition to CMS, some WorkSafeBC operations will be temporarily halted while staff are trained to use the new system. During the week of 4 to 8 May, when the old system is no longer functioning and the new one is not yet operating, the organization will only adjudicate urgent claims. At this time, all urgent medical matters will remain a priority, and your medical care need not change. However, we expect some disruptions and ask for your patience during the transition and start-up process.
Should you encounter problems with the new adjudication system once it is implemented, or if you have questions, or wish to acquire additional information about this system, please contact WorkSafeBC Medical Services at 604 244-6224 or toll free at 888 967-5377, extension 6224.
—Peter Rothfels, BEd, MD, ASAM
WorkSafeBC Director of Clinical Services,
Chief Medical Officer
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