Hearing service providers use this four-page WCB Saskatchewan form to request funding for a worker with a work-related hearing loss claim. Part 1 covers new or replacement hearing aids, the reasons for replacement and the invoicing codes. Part 2 covers repairs after the warranty, supplies such as receivers and ear molds, and service visits beyond the four per year that are pre-approved.
The hearing service provider, an audiologist or hearing instrument practitioner, completes both parts with the clinic and provider numbers and signs where the form asks for the care provider's signature. The WCB completes the 'WCB response' boxes, marking each request approved or denied.
Download the current version from the source each time; forms change without notice.
Hearing loss – Request for funding (MCARE)
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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The MCARE lists the accepted reasons, ear by ear: improper amplification for the hearing loss, improper fit causing feedback, a work-related change in hearing of 20 dB at three or more frequencies, a style that no longer suits the worker (for example because of dexterity), repairs that are no longer cost-effective, or loss or damage. Each request needs WCB approval.
Four. Part 2, section D asks for authorization when a service visit would exceed the pre-approved four visits per year, with the visit number and the reason for the extra visit. Servicing under fee code 214 is billable only after the first year, which the WCB prepays through the fitting code 213.
Only beyond set limits. Part 2, section C asks for authorization for ear molds under fee code 215 when they exceed one mold per ear every two years, and for a receiver needed after the warranty has expired. Give the expected cost, and the WCB marks the request approved or denied in its response box.