C-568 Medical Care Invoice Instruction - Fill out required fields

Sep 21, 2026

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C-568 Medical Care Invoice instruction text explains how to complete Alberta workers’ compensation medical billing fields accurately. It covers required identifiers such as WCB claim number and patient information, plus date of service, health service codes, diagnostic codes (ICD-9 based), modifiers, locations, calls, encounters, and fee amounts. The guide also states when to submit supporting reports, how billing numbers and contract IDs are used, and the rules for listing services separately and returning incomplete or illegible invoices.

LanguageEnglish

CategoryInvoices

FormatPDF

Pages2

Reading Time1 min

AccessFree to download

Medical Care Invoice Instruction

Required identifiers and patient information

Date, codes, modifiers, and service details

Billing numbers, contract ID, and skill code

General invoicing rules and resubmission

C568 MEDICAL INVOICE P.O. BOX 2415 EDMONTON, AB T5J 2S5 FAX: 780-427-5863 1-800-661-1993 WORKER DETAILS | WCB Claim Number | | --- | | Personal Health Number | Date of Service Health Service (yyyy/mm/dd) Code Diagnostic Code Modifier Skill Code Calls Encounter Fees Submitted $ Total Amount Billed: $ | Billing Number | | Contract ID | Facility Type | | --- | --- | --- | --- | | Name and address to whom fee is payable:(please print) | Signature | | Printed Name | | | Telephone Number
Provider's Reference Number | | Fax Number
Date (yyyy/mm/dd) | THIS DOCUMENT MAY BE EXAMINED BY ANY PERSON WITH DIRECT INTEREST IN A CLAIM THAT IS UNDER REVIEW. C-568 REV JULY 2020 Medical Care Invoice Instruction This guide provides some instructions and relevant information for various fields on the Medical Care Invoice. For a more detailed explanation or to discuss billing procedures, please contact the WCB Claims Contact Centre at 780-498-3999. The WCB claim number is required. This can be obtained by calling the WCB Claims Contact Centre at the above number. All information regarding the patient must be completed. Date of Service-This date refers to the actual date the service was provided. Health Service Code-These codes are based on the Alberta Health and Wellness Schedule of Medical Benefits or codes created by the WCB and relate to the service/procedure that was performed. Codes used by orthopaedic surgeons are outlined in the W.C. B./Orthopaedic Surgeon-Fee Schedule. Diagnostic Code-Diagnostic codes are based on ICD-9 codes and refer to the diagnosis for which the patient is being treated. One diagnostic code must be entered per service/procedure. However, in some cases there could be two to three diagnostic codes per service/procedure. If a diagnosis is not known at this time, please provide a provisional diagnosis. Modifier-This is used for explicit fee modifiers required to identify the nature of the service for payment purposes. Some values include: UGA-Procedure under general anaesthetic, EV-Evening Location-This is the location where the service/procedure was performed. Values include: Clinic, Facility Non Hospital, Hospital, or Other. Calls-Calls is used to indicate either the number of consecutive hospital visit days, the number of services performed, or the number of units (e.g. 15 minute time blocks) required. Encounter-Encounter indicates if the service was performed during the first, second, third, etc. time the practitioner saw the patient on the same day. Amount-Refers to the fee billed for the service/procedure provided. Total Amount Billed-This refers to the sum of the fees billed for the service/procedure provided. Type of Report submitted with this invoice-In most cases, a Medical or Consultation report should be sent along with the invoice. Please check the appropriate box indicating what type of report was submitted with the invoice. Name and address to whom fee is payable-This field identifies the name and address of the practitioner to whom the amount is payable. Telephone Number-This is the phone number where the practitioner can be reached. WCB Billing Number-The WCB billing number is a unique number which identifies the practitioner who provided the service. It identifies who the payee is and to what address payment should be made. The WCB billing number is required. Contract ID-The Contract ID is attached to your billing number and will automatically be populated within the system at WCB. If applicable, Health Care Services will notify you of your Contract ID. Skill Code-Skill Code is the practitioner's skill code for the service provided. Examples of skill codes include: GP-General Practice, ORTH-Orthopaedic, PLAS-Plastic Surgery. General Information All services/procedures should be invoiced on this form only. Each service/procedure must be listed on a separate line. Incomplete or illegible invoi

FAQs

Which fields are required before submitting the C-568 medical invoice?

The WCB claim number is required, and all patient information must be completed. The WCB billing number identifying the practitioner is also required.

How should the Date of Service and coding fields be entered?

Date of Service is the actual date the service was provided. Health service codes and diagnostic codes must match the Alberta schedule or ICD-9 basis, with one diagnostic code entered per service/procedure unless multiple codes are applicable.

What are the general submission rules for services and invoice quality?

All services/procedures should be invoiced using this form only, with each service listed on a separate line. Incomplete or illegible invoices are returned unpaid, and if a C-568 was submitted with an error the practitioner must submit a Medical Service Re-Assessment (C570) form.

Sep 21, 2026

Upload by Eden