Important Form CMS-1500 Reminders for Providers
Effective July 1, 2021, all Board-authorized health care providers need to:
-
Register for XML submission with your NPI number. If you do not register for XML submission with your NPI number, your bill may be rejected. The registration process takes time, and the Board recommends getting started soon.
- Sign, notarize and return the XML Submission Agreement to the Board. A separate agreement is required for every treating provider.
- Submit Form CMS-1500 and the medical narrative/attachment electronically through an approved XML submission partner.
- Attach the Explanation of Benefits with the insurer Claim Adjustment Reason Codes (CARCs) to the Request for Decision on Unpaid Medical Bill(s) (Form HP-1).
Between now and the implementation date, health care providers are urged to review their processes to understand how to incorporate these changes. The Board will post periodic updates to the website based on feedback and questions from stakeholders.
Form CMS-1500 Background
As you are aware, the Workers’ Compensation Board is transitioning to using the Form CMS-1500, which will streamline the medical billing process and reduce the paperwork requirements currently in the workers’ compensation system. Ultimately, it is expected that a more straightforward billing process will ensure more timely payments and less billing disputes, leading to better and more timely care for injured workers.
Additional Resources
Presentation for providers
A recorded presentation for providers (published September 2020) answers several of the most frequently asked questions regarding the Board's transition to Form CMS-1500 as well as the Board's implementation of the Expanded Provider Law.
Form CMS-1500 training video
The Board has developed a training video to show health care providers, and all others who will be using Form CMS-1500, how to use the form and the required narrative reports to bill for their services to workers’ compensation patients. To view the training video, follow this link: CMS-1500 Training Video.
Resources
You can visit the Board’s website for a CMS-1500 overview, news, FAQs, and more.
Contact
For Form CMS-1500 feedback and questions, email CMS1500@wcb.ny.gov. For clinical feedback and questions, email provider@wcb.ny.gov.
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