Physicians and nurse practitioners can refer patients with a WorkSafeBC claim to a specialist and have it billed to WorkSafeBC. No prior WorkSafeBC authorization is required by the referring clinician or the receiving specialist as long as the referral is for the injury, mental health condition, or occupational disease accepted on the claim (even if the decision on whether the claim can be accepted is still pending). Check the status of a claim at https://pvc.online.worksafebc.com.

Routine referrals

Make routine referrals as you would for patients without WorkSafeBC claims. Indicate your patient’s claim number prominently in the referral letter so WorkSafeBC is billed for the visit instead of MSP.

Expedited referrals

Why expedite?

For patients off work, every day away increases the risk of chronic worklessness with its associated medical and social harms.[1] To help protect your patients’ livelihoods, WorkSafeBC supports expedited referrals to specialists either by direct referral to a community specialist willing to expedite an appointment or by requesting a referral to the Richmond WorkSafeBC Visiting Specialist Clinic (VSC).

How to request an expedited referral to a community specialist/clinic

1. Find a specialist/clinic willing to expedite a referral. Specialists do not require authorization from WorkSafeBC to expedite a patient encounter for patients with pending or accepted WorkSafeBC claims as long as they can incorporate this into their patient flow. However, you will need to find a specialist willing to expedite appointments.

Use Pathways BC (https://pathwaysbc.ca) to help: search “WorkSafeBC,” “expedited,” and the specialty or clinic type for a list of specialists interested in providing expedited appointments for WorkSafeBC patients in your area.

Note to specialists: Check your profile and your clinic’s profile on Pathways BC to ensure it reflects your interest (or not) in expediting appointments for patients with a pending or accepted WorkSafeBC claim.

2. Write a referral letter prominently noting it is a WorkSafeBC patient. Specialists do not require prior authorization from WorkSafeBC to bill for an expedited visit, but they may miss the window of opportunity to meet billing rules[2] if they are not aware that the patient is a WorkSafeBC patient. Displaying the claim number prominently in your referral letter allows them to triage patients accordingly.

Note to specialists: Use fee codes 19911 and 19912 for expedited consults—see the billing guide for these codes (www.worksafebc.com/en/resources/health-care-providers/guides/how-to-bill-fee-code-19911-19912).

How to request an expedited referral to the Richmond WorkSafeBC VSC

Physicians and nurse practitioners can request that their patients be seen at the Richmond WorkSafeBC VSC (https://pathwaysbc.ca/clinics/47; login required). If the request is approved by the WorkSafeBC decision-making officer assigned to your patient, the WorkSafeBC medical advisor will write a referral on your behalf, and the VSC will contact your patient with the date and time of the appointment.

There are three ways to request a VSC referral:

• Make a RACE request (www.raceconnect.ca) by phone or through the app.
• Leave a voicemail on the WorkSafeBC medical advisor information line at 1 855 476-3049. Your message will be picked up within 24 hours on business days and routed as high priority to one of our physicians.
• Indicate your interest on Form 8/11 by checking the box to contact a medical advisor. In the text area, explain that you need a referral to the VSC and don’t need a phone call as long as the referral is made. (Caution: If you fill in the text area but do not check the box to speak to the medical advisor, your request may be missed.)

If you cannot find a community psychiatrist to see your WorkSafeBC patient

If you have trouble finding a psychiatrist to see your WorkSafeBC patient for a mental health condition through a community referral, expedited or not, contact a medical advisor to discuss. We may be able to facilitate a referral to a roster of psychiatrists who see injured or ill workers. You can make a request to WorkSafeBC through RACE, leave us a voicemail on the WorkSafeBC medical advisor information line at 1 855 476-3049, or indicate your need on Form 8/11 and check the box to contact a medical advisor.

Please note that WorkSafeBC does not run an emergency/urgent care service. For emergency/urgent situations, use the same community services you would for patients without a WorkSafeBC claim (i.e., facilitate steps for your patient to be seen through hospital emergency services).
—Celina Dunn, MD, CCFP
Medical Services Manager, WorkSafeBC

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This article is the opinion of WorkSafeBC and has not been peer reviewed by the BCMJ Editorial Board.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

1.    Waddell G, Burton AK. Is work good for your health and well-being? London, UK: The Stationery Office, 2006. Accessed 24 May 2023. www.gov.uk/government/publications/is-work-good-for-your-health-and-well-being.

2.    Wong P, Chmelnitsky D, Ferdowsi F. Tips for billing Initial Expedited Comprehensive Consultations (19911). BCMJ 2022;64:249.