New claims system nears completion

The impact on your patients

WorkSafeBC’s new Claims Management Solutions (CMS) system (discussed in last month’s column) will soon be up and running. The new system will electronically field and gather claim information received from injured workers, employers, and physicians; automatically adjudicate claims; and, in most cases, pay worker benefits and health care provider billings. Conversion from the old system to the new one will begin in the next few months and take approximately a month to complete.

During the transition, service will be disrupted while the existing system is decommissioned, the new one implemented, and staff undergo training. During this time, urgent medical matters will remain a priority; however, please be aware of the following:
• Only urgent claims will be adjudicated; however, all claims will be prepared and ready for input as soon as the new system is operational.
• Once conversion begins, physician payments will be disrupted for up to 4 weeks, but invoices will be accepted during this time—ready for input and payment as soon as CMS is up and running.

What’s new?
Once the new system is operational, please remember to do the following:
• Use the new bar-coded Forms 8 and 11, available in the forms section of the Health Care Provider pages at WorkSafeBC.com. Since all forms will be entered into the system by barcode, it’s essential that you use these new forms.
• Use appropriate ICD-9 diagnosis codes as indicated on the table that will be available at WorkSafeBC.com. In the new system, medical and payment information will be based on ICD-9 diagnoses.
• Send only information that’s relevant to your patient’s WorkSafeBC claim. Under the new system, workers will have an easier time viewing their claim files; as such, we expect more injured workers will read their medical reports.

Sensitive information
As always, please ensure that all medical information sent for inclusion in an injured-worker patient’s claim file is relevant to the claim. Sensitive information that is not relevant to the claim should never be sent in. However, you should continue to provide documentation of sensitive biopsychosocial information related to prolonged disability. WorkSafeBC non-physician staff vet all medical documents for relevancy prior to filing a claim (except Form 8s); we also ask that you verify relevancy to comply with legislative and ethical requirements before sending us the information.

Return-to-work enhancement
The CMS system inserts an anticipated return-to-work date on an injured worker’s claim file to alert WorkSafeBC staff when an individual may be at risk for permanent withdrawal from the workplace. At that time, the injured worker and physician will be provided with resources aimed at restoring the individual to a fully functioning state and helping them return to work.

Research shows that approximately half of all patients who are off work with common conditions (such as back pain or asthma) for as little as 12 to 24 weeks never return to work. The attendant medical, social, family, and financial impacts associated with prolonged unemployment and disability affect a patient’s health and well-being.

For more information
If you have any questions or concerns regarding the new CMS system, your invoicing process, or what information you should send to WorkSafeBC, please contact WorkSafeBC Medical Services at 604 244-6224 or toll free 1 888 967-5377, extension 6224.

—Peter Rothfels, BEd, MD, ASAM
WorkSafeBC Director of Clinical Services and Chief Medical Officer

CORRECTION
Re: Registration requirements for physicians, September 2008
Please note the following two errors in our text:
• Scenario #5: Dr Jamison provides services exclusively to one health authority, bills the Medical Services Plan for his services, and has no workers. Is he considered a worker? Originally, we wrote “yes.” However, the correct answer is “no.” In fact, Dr Jamison is an independent operator, with an independent business, whose income is derived through either a service or a sessional contract. Dr Jamison may choose to purchase Personal Optional Protection.
• Service representatives in WorkSafeBC’s Employer Service Centre are available Monday through Friday, from 8:30 a.m. to 4:30 p.m.—not 8 a.m., as previously stated.
The September article, with corrections, will run again in next month’s issue.