Mental Health & Therapy Claim AI Blueprint — EHB, WSIB & EAP for Ontario Practices
Ontario mental health and therapy practices face billing complexity that most clinic management software handles poorly — designation coverage rules, EHB session limits, WSIB psychological injury claims under Bill 27, and EAP-to-EHB transitions that most clients don't even know exist.This DIY blueprint gives you three complete Make.com + Claude API automation modules. Set it up in your own Make.com account in under 2 hours. Your client data stays with you. MODULE A — EHB Session Tracking + Designation CoverageAI tracks every EHB session per client across Sun Life, Manulife, Canada Life, Blue Cross, and Desjardins. Checks whether your designation (Psychologist, RP, or RSW) is covered by the client's specific plan before billing. Sends a warning alert when 2 sessions remain so clients are never surprised. Drafts denial appeal letters instantly. MODULE B — WSIB Psychological Injury ClaimsOntario's Bill 27 expanded WSIB to cover mental health treatment for workplace psychological injuries — but claims require specific documentation that many psychologists don't know. AI generates Form 6 guidance, progress report templates (required every 6–8 sessions), and functional ability statements for return-to-work planning. MODULE C — EAP Session Tracking + EHB HandoffEAP sessions (LifeWorks, Homewood, Optum, Morneau Shepell) do NOT count against EHB annual maximums. But when EAP runs out, clients often don't know to switch to their EHB benefits — and billable sessions are lost. Module C tracks EAP sessions and automatically triggers the EHB transition with a client notification. WHAT'S INCLUDED:- All 3 complete Make.com workflow blueprints- 3 Claude API system prompts — EHB Coverage Check, WSIB Psych Claims, EAP Transition- Ontario EHB Mental Health Coverage Guide (which designations each insurer covers)- Google Sheets 4-tab client session dashboard setup guide- Step-by-step setup guide (under 2 hours)- Session limit warning system — auto-alerts when 2 sessions remain- Phase 2 expansions: WSIB progress report reminders, monthly revenue report, MVA psych claims- Done-For-You setup available at $497 TOTAL RUNNING COST: $14–$31 CAD/monthOne recovered EHB denial ($120–$200/session) pays for months of this system.Works for: Registered Psychotherapists (RPs), Registered Social Workers (RSWs), Psychologists, couples & family therapists, trauma specialists, and group therapy practices.NOTE: Your client data stays in YOUR Google and Make.com accounts. artefac.digital does not store, process, or access your practice's client information.---TAGS:mental health billing, psychotherapist, registered psychotherapist, RSW, psychologist, EHB Ontario, WSIB mental health, EAP, Make.com, Claude API, Ontario therapy
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