WCB Agreement FAQs

No, WCB payments are part of an independent budget funded by employer premiums.

WCB services are unique and expedited and physician services require the exchange of additional information. In recognition, higher fees are paid in the interest of caring for injured workers and getting them back to work as quickly as possible.

The WCB and Alberta Orthopedic Society determined there is value in having a separately negotiated contract. Some of the provisions contained within this agreement have helped move toward a better balance between the two.

The term of the current agreement is January 1, 2025 - December 31, 2029.

WCB uses specialty designations as recognized by the Government of Alberta for physician payments (FFS and alternative compensation) and the College of Physicians and Surgeons of Alberta (CPSA).

If no increases to the SOMB are implemented within any year of the agreement, each of the WCB-specific code fees (except for premium codes) will be increased by 1.65%, effective April 1st of that year. This is an increase from the 1.60% increase in the previous WCB-AMA Agreement.

This code is from the Schedule of Medical Benefits (SOMB). Increases to the SOMB are tied to the AMA’s agreement with Government and so are dependent upon whatever is negotiated for that agreement.

The percentage increases negotiated for the tentative WCB-AMA Agreement apply to WCB specific codes only, which are not billable to Government.  In those years where there is no increase to the SOMB, WCB will increase its specific codes by 1.65%.

Requirements for using the CMGP modifier (time requirements, work must occur on the same date as the patient is seen, no claims for concurrent or overlapping time) remain when claiming under the WCB agreement.

BCP payments for WCB visits are tied to the AMA’s agreement with Government and so are dependent upon whatever is negotiated for that agreement. 

The percentage increases negotiated for the tentative WCB-AMA Agreement apply to WCB specific codes only, which are not billable to Government.  In those years where there is no increase to the SOMB, WCB will increase its specific codes by 1.65%.

Independent Medical Examinations (IMEs) are outside of the scope of the tentative WCB-AMA Physician Services Compensation Agreement. The increases in the current contract do not apply to the IME codes.

This is a standard legal clause in many contracts. It means that the specified time and dates in the agreement are important and mandatory.”

The same-day and on-time reporting incentives apply to encounters both in and out of office settings for general practitioner (GP) first reports, specialist consultation reports and all follow-up reports.

• “Same day report submission” means that the report is received by WCB on the same date as the completed examination (GP or specialist) which includes up to 10:00 a.m. MT the next business day.
• “On time” is defined as receipt within three business days from the date the worker saw the physician for GP reports, again up to 10:00 a.m. MT the next business day.
• “On time” for all other reports (specialist and follow ups) is defined as receipt within four business days from the date the worker saw the physician, up to 10:00 a.m. MT the next business day.

It is in everyone’s interest for the patient to be treated, recover, and return to work as soon as possible. The agreement provides financial incentives that encourage more timely reporting.

There are differential rates for reporting the same day, on time and late. The same-day fee is substantially higher fee for same-day reporting and many physicians can adapt their business processes and systems to meet the requirements most of the time.

The on-time fee recognizes that physicians who are extra busy (e.g., in the emergency department) may not be able to meet the “same day” target.

The late fee is applied when a physician is unable to submit the report within the on-time requirement.

The CMGP modifier applies to all activities relating to patient care (e.g., reviewing documents before seeing the patient, seeing, and examining the patient, charting, etc.). The modifier cannot be used for completing the WCB report because the WCB reporting fee code compensates for this activity.

• “Same day report submission” means that the report is received by the WCB on the same date as the completed examination (GP or specialist) up to 10:00 a.m. MT the next business day. If the patient registers at 23:30 hours on January 15th in the ED, but was not seen by the physician until 05:00 hours on January 16th, then the WCB report would be due at 10:00 a.m. on January 17th (or next business day if that day falls on a weekend).
• “On time” for GP first reports is defined as receipt within three business days from the date of the completed examination up until 10:00 a.m. MT on the fourth business day following the completed examination.
• “On time” for all other reports (GP progress report, and specialist consultation and follow up report) is defined as receipt within four business days from the date of the completed examination up until 10:00 a.m. MT on the fifth day following the completed examination.
• “Late” is defined as receipt any time after the designated on-time report submissions.

The time stamp occurs when all documents are submitted to WCB, including the invoice. This is because the WCB has no other way to confirm/audit whether this time is correct and cannot begin the process without the complete set of data.

The following time frames apply:

• "Same day report submission” means that the report is received by WCB on the same date as the completed examination (GP or Specialist) which includes up to 10:00 a.m. MT the next business day
• “On time” is defined as receipt within three business days from the date the worker saw the physician for GP reports up to 10:00 a.m.MT the next business day.
• “On time” for all other reports (specialist and follow ups) is defined as receipt within four business days from the date the worker saw the physician, up to 10:00 a.m. MT the next business day.
• If there is an error or outage with myWCB or Rapid Report, report fees will be determined based on the submission date and time, rather than on the processed date and time. This will ensure that report submissions are paid accurately, even if myWCB is experiencing an outage (scheduled or unscheduled)
• In the event of an internal error with myWCB or Rapid Report, WCB will honour the higher differential report fee as is their historical practice.

WCB will also accept an Emergency Department report from ConnectCare as proof of same-day or on-time report, if myWCB is experiencing an outage.

When an employer requests a physician to complete extra forms that are not WCB forms, the physician can bill the employer directly.

No. The AMA negotiates with the WCB on behalf of all physicians. This means that all physicians providing services in Alberta are covered under the AMA agreement with WCB, which prescribes fees/rates to be billed. The WCB pays fee-for-service as per the SOMB plus additional WCB fees for reports, expedited services, etc.

Yes, if the physician believes the injury occurred in the course of the patient’s employment, the injury must be reported to WCB. Section 34 of the Alberta Workers’ Compensation Act outlines reporting requirements physicians are required to meet.  In the event that the worker or employer requests the physician not report, or the physician believes the injury is work-related but the patient will not disclose, the physician must report the injury to WCB and may charge WCB for the report and any care provided. WCB has access to information that will allow it to investigate to determine the patient’s employer and whether the injury occurred in the course of the patient’s work. In addition, treatment of work-related injuries should be billed to WCB rather than Government of Alberta.  Payment made to physicians by government for work-related injuries will be recovered by Alberta Health.