CMS-1500 Form: July 1 Implementation Reminders for Health Care Providers

New York State Workers' Compensation Board sent this bulletin at 06/27/2022 01:00 PM EDT

CMS-1500 Form: July 1 Implementation Reminders for Health Care Providers

The July 1, 2022, CMS-1500 form implementation is almost here!

As you are likely already aware, the Workers’ Compensation Board (Board) is transitioning to the CMS-1500 form, which will streamline the medical billing process and reduce the paperwork requirements currently in the workers’ compensation system. It’s expected that a more straightforward billing process will draw more health care providers into the system, leading to better access to health care providers and more timely care for injured workers.

We want to make sure you are fully prepared for the July 1 implementation. Read on for some important reminders to be aware of.

Requirements Starting July 1, 2022

Beginning July 1, 2022, health care providers are required to:

  • Use the CMS-1500 form for all workers’ compensation medical billing. Electronic submission through an XML submission partner is strongly encouraged, though not required at this time. 
  • Include in the medical narrative attachment the injured worker’s
    • temporary impairment percentage,
    • work status, and
    • the causal relationship of the injury

either at the top of, or prominently displayed on the medical narrative that accompanies the CMS-1500 form.

Important: If any of these elements are missing, the medical narrative report may be found legally defective, which means you may not be paid for rendered services. Bills for ancillary services such as radiology, anesthesiology or surgery have unique attachment requirements.

To ensure the CMS-1500 form is accepted, the Board has developed a medical narrative report template that can be used to create the medical narrative report that accompanies provider submissions of the CMS-1500 form.

Should you need additional space on the CMS-1500 form to fit all services/modalities for which you are submitting charges for a specific date of service, please utilize additional CMS-1500 forms. Enter the total amount for all services being billed on the final page of the final CMS-1500 form and submit with the narrative attachment to the insurer on the same day.  Please do not total each CMS-1500 form individually, as each individual total per CMS-1500 form will be considered a separate bill for the same date of service, and only one may be processed. 

Benefits of XML Submission

We encourage you to start using the CMS-1500 form now. Electronic submission offers numerous benefits:

  • Confirmation within seven days that a bill was accepted or rejected by the payer.
  • Typically quicker payment.
  • With acknowledgement of receipt from the payer, awareness that a bill should not be resubmitted.
  • Technical errors are identified quickly so they may be corrected and resubmitted, instead of waiting for the payer to deny the bill.
  • Payer acknowledged bills and medical narrative reports will be forwarded to the Board by the XML submission partner on your behalf.

We urge you to review your processes to understand how these changes will affect you. The Board will continue to post periodic updates to the website based on feedback and questions received from stakeholders.

Register for XML Submission

You are likely already signed up to use the Medical Portal, but if not, be sure to register 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.

Discontinued Forms

When mandatory submission of the CMS-1500 form begins on July 1, 2022, use of the following forms will be discontinued:

  • Doctor’s Initial Report (Form C-4, Form EC-4)
  • Continuation to Carrier/Employer Billing Section (Form C-4.1)
  • Doctor’s Progress Report (Form C-4.2, Form EC-4.2)
  • Ancillary Medical Report (Form C-4AMR, Form EC-4AMR)
  • Doctor’s Narrative Report (Form EC-4NARR)
  • Occupational/Physical Therapist’s Report (Form OT/PT-4, Form EOT/PT-4)
  • Psychologists Report (Form PS-4)
  • Ophthalmologist's Report (Form C-5)

Pursuant to 12 NYCRR 325-1.25(b)(1), effective July 1, 2022, bills submitted on any of the above forms shall not be eligible for an award issued through the medical dispute process under the provisions of the Workers' Compensation Law.

We are also seeing a high volume of the soon-to-be discontinued forms being submitted online through the Board’s website. Please note, submitting one of these forms through the Board’s website does not constitute electronic submission. These forms will no longer be available on the Board’s website after June 30, 2022.

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.