CMS-1500 Form – Important Reminders for Health Care Providers
Health care providers are encouraged to sign up for the Medical Portal now so you may take advantage of all the online services the Board offers - including registering for electronic submission of medical bills to payers and the Board.
Once you are registered for electronic submission, you can then discuss details of submission with an approved XML submission partner (also known as a clearinghouse).
You can view instructions for registering for the Medical Portal on the Board’s website.
Important: Effective Date Requirements
Beginning July 1, 2022, health care providers will need to:
- Submit the CMS-1500 form. Electronic submission through an XML submission partner is strongly encouraged, though not required. When mandatory submission of the CMS-1500 form begins, use of current medical billing/reports including Doctor’s Initial Report (Form C-4) and Doctor’s Progress Report (Form C-4.2) will be discontinued.
- Prominently report the injured worker’s temporary impairment percentage, work status and the causal relationship of the injury at the top of the CMS-1500 form medical narrative.
Between now and July 1, 2022 health care providers are urged to review their processes to understand how these changes will affect them. The Board will continue to post periodic updates to the website based on feedback and questions received from stakeholders.
Additional Resources
You can visit the Board’s website for CMS-1500 news, FAQs, and more. The Board has also created a special webpage dedicated to sharing timely updates on various Board initiatives with a health care provider focus. Visit What Providers Need to Know to view the latest!
For CMS-1500 feedback and questions, email CMS1500@wcb.ny.gov. For clinical feedback and questions, email provider@wcb.ny.gov.
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