Mail to:
Workplace Safety & Insurance Board
Health Care Provider Registration
200 Front Street West, 4th floor
Toronto ON M5V 3J1
OR Fax to:
416-344-2955
Health Professional's Application
for WSIB Billing Number
Please print in black ink
How to bill WSIB for Health Services
The WSIB accepts 2 primary methods of billing for health care services.
1. eBilling - The WSIB uses an on-line billing system that is user-friendly and is a valuable business solution used by many health
professionals. TELUS Health Solutions processes invoices for services that are submitted to WSIB via a secure server. If you are
interested in eBilling, please register with Telus and they will issue you a Provider Billing #. Contact information is below:
Visit www.telushealth.com/wsib to register for eBilling or call Telus at 1-866-240-7492 for more information.
2. Manual Bill Submission - If unable to bill electronically, WSIB will issue you a Provider Billing number. If interested in manually
billing only, please complete the application information below and return to WSIB.
Following registration, WSIB will forward introductory information such as explaining how to bill the WSIB, provide your billing number,
and supply information on what to do in the event of facility or address changes.
Health Professional's Information
Health professional - is a member of a College of a health profession as defined in the Regulated Health Professions Act, 1991.
Business Name/Surname First Name Initials
Address Telephone
Province Postal Code Fax
City/Town
HST Registration Number
Email
Licence/Practice Number
Health Professional Regulatory College
Brief Description of Services
Health Professional's Signature
Print Name
Date (dd/mm/yyyy)
Signature
Please return this form to:
Workplace Safety and Insurance Board
Health Care Provider Registration
200 Front Street West, 4th Floor
Toronto ON M5V 3J1
Direct enquiries to: Health Care Practitioner's Access Line
416-344-4526
OR 1-800-569-7919
OR Fax to:
416-344-2955
www.wsib.on.ca
1890A (12/10)
Please print form & sign before returning to the WSIB
