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NEW ICBC CL 489 Reports

notes by Herb Chang based on webinar presentation from UBC CPD/ICBC on April 3, 2019:

After April 1, 2019, legislation has mandated the following changes necessary at ICBC:

Requirement for new reports to replace CL-19: CL 489-Standard Report CL 489A-Extended ReportCL 489B-Reasssessment

Management after MVA allows for automatic pre-authorized treatments for 90 days after accident to allow for early intervention for care, without barriers from the claim process as indicated (i.e. these treatments DO NOT require ICBC pre-authorization or having the patient see a claims adjuster first. You can send them to treatment right away before they have detailed contact with ICBC, provided they have a claim number—see ** below.)

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Note that OT has no limit because they will be expected to co-ordinate some of the care to other providers.

REGISTERED CARE ADVISOR (RCA)-new role defined by legislation-compiled by roster by CPSBC; lists to come; RCA needs MSK injury, chronic pain and mental health understanding and will self-identify to CPSBC-refer to RCA (based from Alberta model) when diagnosis is unclear or not proceeding as expected by 90 days and may refer again up to 9 months from MVA.-send where there are complicating factors or where a second option would be useful-must be considered at 90 days (but not required to be sent to a RCA unless you feel it is necessary)-communication directly by phone, fax, EMR, mail between RCA and patientʼs MD (NOT through ICBC and ICBC does not get a copy, so that ICBC does not influence the care)-NOTE: the RCA cannot provide ongoing care to the patient, only provide guidance and recommendations (ICBC is aware that this may be a problem in smaller communities)-MRP may make up to 2 RCA referrals within 9 months from the accident date-either the same one again or 2 different RCAs

ICBC Medical Reporting:moving from CL-19 to 489/489A/489B“these forms are a living document; and will be changed over time”

A report is NOT required after every visit.

After first or second visit, send CL489 OR 489A as appropriate. These will serve as both the form and the invoice. Do not invoice separately through MSP Teleplan.

Semi-regular visits for followup as appropriate, should continued to be billed to MSP Teleplan with ICBC indicated as the payer (like we do now).

Around 90 days, if not improving or needing further therapy, the MRP should consider about referral to a RCA and complete the CL489B (this will serve as both the form and invoice and does not require separate billing through MSP Teleplan).

EMR Integration:available in most common EMRs

**Claim numbers are required and critical before sending forms-you will have to wait for patient to provide it before sending the form or you can call ICBC Claims help desk for the claim number if the patient does not provide it. The claim number must be provided on the forms.

Standard report 489/Extended report 489A-similar to WCB Form 8 initial report -to allow early identification for patients requiring more support for care earlier in the process

-helps ICBC access information for care required earlier in process

Payment:CL 489 (A94564) $120 - Injuries do not result in loss of ability to attend work/schoolCL 489A (A94565) $325 - Injuries are significant and result in patient being unable to work/attend school full-timeCL 489B (A94566) $210 - Injuries are not recovering as expected at 90days. MRP to refer to RCA or MRP can continue current treatment/change in treatment (with recovery expected soon); CL 489B is to be completed by the patientʼs primary care provider (MRP).

===================================================Case 1Carl

on initial visit:MVA, rear-ended, has reported accident to ICBC and has a Claim #complaining of neck pain, worse at work this AMpatient has not missed any work or other ADLs despite the painPLAN: Use CL 489 in place of your SOAP note; indicate the treatment plans suggested (Make standard recommendations for stretching, physio, work ergonomics, etc.)FAX or mail the report to ICBC (DO NOT send via MSP Teleplan. ICBC is working towards a WCB-like solution in the future to be able to send by Teleplan, but did not have time to have this set up by April 1, 2019.)

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DETAILS of FORM CL 489-Standard Report:

How to fill out Report:

https://www.icbc.com/partners/health-services/Documents/how-to-fill-out-

standard-medical-report.pdf

VENDOR Number-if you have EVER sent anything to ICBC to be paid, you will have one already or you can contact ICBC at: claimsvendorinquiry@icbc.com

Are you the patientʼs regular practitioner? If no, send the patient back to their regular physician for follow up. If no regular physician, then WIC can continue to see.

INVOICE Number-this is YOUR invoice number (not from ICBC)

Protocols and Guidelines-using Evidence-Based Treatments: Professional experience will be accepted. Concussion protocol from SportsMed BC.

CONSENT-NEW

At the end of the form:

Check the first box and you must check one of the next 2 boxes about consent to allow ICBC access to this information to allow for proper treatment availability to the patient. ICBC claims that this will speed up claims process and access to care.

Practice resource consent form from Doctors of BC.

https://ubccpd.ca/sites/ubccpd.ca/files/Consent-to-Release-Reports-ICBC-ID265906.pdf

If patient refuses consent, then ICBC can request it by Legislation.

https://www.icbc.com/partners/health-services/Documents/patient-consent-considerations.pdf

ICBC recommends “Consent by standard principles-written consent as appropriate, verbal can be accepted.” (However SGP does recommend signed written consent).If patient does not consent, then identify so when ICBC requests this information.e.g. if patient sees a lawyer and does not provide consent, then ICBC will request as allowed by Legislation and you will click on the appropriate box

Note: if the patient does not provide consent, they are still entitled to the pre-authorized treatments for up to 90 days. Even if uncertain it is a WCB case or ICBC case, then ICBC will still cover care until it is sorted out as to which agency is taking responsibility.In these cases, then bill visit to MSP Teleplan with ICBC responsible. Wait for ICBC to request the report and then file it with the box clicked on the second box. (Uncertain if we need to recall the patient to complete another visit or if we just file the report based on the previous visit, as the form fee includes a visit fee or if the form fee will be reduced by the prior visit fee?)

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Case 1 (continued) Re-assessment at 6 weeks:Recovery of patient with no on-going symptomsBill ICBC for visit as usual via MSP Teleplan. After case closed, then any further billings are through MSP.

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Case 2BrianneMVA with fracture to arm, head injury, anxietyUnable to work, no savingsPLAN: Use CL 489A.

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DETAILS of FORM CL 489A-Extended Report:

Are there other medical conditions (non-accident related) that are contributing to the current diagnosis or symptoms?

Enter the OBJECTIVE findings in section 9Other medical conditions added to section 10 and additional comments in section 14.

Do I support a GRTW program? NO for a complicated case. Can provide an expected DURATION, if appropriate. Complicated cases will be transferred to an ICBC “Customer Recovery Specialist” for clients that are unable to RTW by 30 days. The CRS will have greater training that the regular claims adjuster about management of patients with more significant injuries.

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Case 2 (continued)

Referral to OT for concussion management and recovery as well as for R. arm # recovery

Followup visits re: anxiety. Bill these visits through MSP Teleplan with ICBC indicated as being responsible.

CRS will help set up a GRTW as appropriate.

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DETAILS of CL489B-Reassessment Report:

-to be filed at 90 days by the patientʼs MRP-consider referral to Registered Care Advisor (RCA)-purpose of report is to allow for changes/extension of care outside of automatically pre-authorized treatments-allows for management of mood changes, chronic pain

Patientʼs MRP will remain responsible to make the referral to the RCA. ICBC does not appear to be able to help with the process (unlike WSBC).

Do we specify which RCA we want? Yes you can identify on the CL 489BLook up on the roster (being finalized now; will indicate specialties, focus of practice, check on Pathways??)

Has the Diagnosis of the Injuries changed?

*****NOTE: CL489B reassessment form can be used for patients with existing claims with injuries BEFORE April 1, 2019, if they are not recovering as expected (at around 90 days).

==========================================================Case 2 (continued)

Patient seen by RCA and recommendations made for care.Assistance by the ICBC CRS do develop a GRTW, when appropriate.Ongoing care with GRTW at 9 months

Closure of case after another 5 months of physio and CBT

==========================================================Case 3-Rekha

MVA with whiplash type injuries.Unable to work due to neck symptoms Use CL 489A

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Questions:

CL 489/489A should be completed by the patientʼs MRP. If WIC completes, then should indicate they are not the patientʼs MRP.Even if the WIC has been completed CL4889/CL489A already, then ICBC should still pay for the form completed by the patientʼs MRP, as there may be some information about prior medical history that WIC does not provide.

Patient seen early in accident—no missed time from work==>complete the CL489. Later they miss work due to the injuries. Monitor clinically. May send a quick note to the Claims Handler (webinar did not clarify how this is to be done and if there is payment for this). If prolonged injury and unable to work then complete the CL 489B as appropriate.

If you receive a CL-19 sent out already, it should still be completed as requested.No further CL-19 are to be sent out effective April 1, 2019.

Here is the link to the Doctors of BC consent template: https://ubccpd.ca/sites/ubccpd.ca/files/Consent-to-Release-Reports-ICBC-ID265906.pdf

Here is a link to all of the resources mentioned: https://ubccpd.ca/icbc

Here is link to ICBC Health Care Providers Q&Aʼs: https://www.icbc.com/partners/health-services/Documents/health-care-partners-qa.pdf