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Getting approval for treatment

Before starting treatment, follow the steps for approval outlined below.

If an injured worker is seeking a minor repair, maintenance, or consumables*:

  1. Assess the worker.
  2. Proceed with minor repair or maintenance or provision of consumables. As long as the service or provision is within the contract terms, pre-approval is not required.
  3. Submit the Notification for Prosthetic Maintenance and Repair (83D18) form within three business days of the date of service.
  4. Once the service is completed, invoice using the Invoice for Prosthetic Services (83D13) form.

See Prosthetic Services Authorization Process.

If an injured worker is seeking any prosthetic service not captured by minor repairs, maintenance, and/or consumables*:

  1. Assess the worker.
  2. Submit Request for Pre-authorization for Prosthetic Services (83D19) within three days of the assessment and await Claim Owner decision.
  3. If pre-approval is received, you can:
    • Start manufacturing the prosthesis, and/or
    • Complete the major service, and/or
    • Supply the liner
  4. Once the service is completed and after the final fitting, invoice using the Invoice for Prosthetic Services (83D13) form.

See Prosthetic Services Authorization Process.

* Please note: Minor repairs, maintenance and consumables are considered any service pertaining only to fee codes Minor Components / Materials (1100589), Labour (1100581), Shipping (1193472), and/or Consumables (1100590). Services requiring fee codes other than or in addition to these require prior approval, and must be submitted using Form 83D19 – Request for Pre-Authorization for Prosthetic Services.