CMS-1500 Form: Important Reminders for Payers

On September 29, 2021, the Chair of the Workers’ Compensation Board (Board) issued Subject Number 046-1452 announcing updated payer requirements and an implementation scheduled for the Board’s CMS-1500 initiative.

Please be reminded of the following:

• The new electronic billing process requires payers to partner with at least one Board-approved XML submission partner to transmit and accept health care provider medical bills via Electronic Data Interchange (EDI) or another agreed upon format with the XML submission partner starting October 1, 2021.

Please note that noncompliance with this directive may result in monetary penalties, including referral to the New York State Department of Financial Services.

• Payers must notify the Board of their designated XML submission partners and keep partner contact information accurate and up-to-date.
• Payers are also required to notify the Board of any changes within three (3) business days.

A listing of approved XML submission partners for the CMS-1500 initiative is posted on the XML Forms Submission section of the Board's website and is updated after each entity successfully completes testing and executes an XML submission partner agreement with the Board.

Payers' Medical Portal Online Administrators can use the online administrator application to designate their XML submission partner(s). Information for payers' XML submission partner designation is on the Board’s website.

Additional Resources

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

For CMS-1500 feedback and questions, or to request a copy of Forms C-8.1B and C-8.4, email CMS1500@wcb.ny.gov.