Update Regarding Health Care Practice Management Software

Update Regarding Health Care Practice Management Software

You are receiving this message because your email address was provided to us in a survey of health care providers who submit medical bills for workers’ compensation in New York State.

The New York State Workers’ Compensation Board (Board) is transitioning to using 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 draw more heath care providers into the system, leading to better access to health care providers and more timely care for injured workers.

The new Form CMS-1500 effective dates are as follows:

  • Beginning October 1, 2021, payers are mandated to receive electronic medical bills.
  • Beginning July 1, 2022, the use of Form CMS-1500 will be mandatory, and electronic submission through a clearinghouse will be strongly encouraged, although not required. Additionally, payers will be required to transmit electronic explanations of reimbursement and use of the recently updated Notice of Treatment Issue/Disputed Bill (Form C-8.1) and Notice to Health Care Provider and Injured Worker of a Carrier's Refusal to Pay All (or a Portion of) a Medical Bill Due to Valuation Objection(s) (Form C-8.4).

Earlier (voluntary) adoption by health care providers is encouraged.

Prepare now

As a company affiliated with health care practice management, you can help your health care provider customers prepare for this transition. Several XML submission partners have been approved for Form CMS-1500 submissions. We encourage you to partner with one or more approved XML submission partners so that your health care provider clients can more easily transition to electronic billing.

Additionally, please be aware that to submit Form CMS-1500 electronically, you must have the technological capability to send medical billing information and required attachments to the clearinghouse.

OnBoard Project

Those who submit medical bills on behalf of health care providers should also be aware that, in addition to the transition to Form CMS-1500, the Board is in the process of making other improvements, including developing a new business information system, OnBoard. OnBoard will be a Better System for a Better Board – providing an intuitive, user-friendly system, increased accuracy and quality, and paperless transactions to our system participants.

Since building a new, integrated system from the ground up takes time, we’re starting with some high-priority processes that will benefit from moving online in what we are referring to as OnBoard: Limited Release.

Visit the Board’s OnBoard webpage to learn more and stay engaged as this project progresses.

Additional Resources

You can visit the Board’s website for Form CMS-1500 overview, news, FAQs, and more.

For Form CMS-1500 feedback and questions, email CMS1500@wcb.ny.gov. For clinical feedback and questions, email provider@wcb.ny.gov.