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The Workers’ Compensation Board (Board) is requiring health care providers to submit the CMS-1500 universal billing form electronically through a Board-approved electronic submission partner, effective August 1, 2025. Starting that date, if the Board receives a paper CMS-1500 form, it will be added to the case file (like any medical evidence received), but the Board will not act on or enforce payment of the form and workers’ compensation payers can deny it.
Please note: all payers must accept electronic transmission of health care provider medical bills. Review Subject Number 046-1418 for additional details.
DENYING PAPER BILLS
If payers receive a paper CMS-1500 bill on or after August 1, 2025, do not submit a Notice of Objection to a Payment of a Bill for Treatment Provided (Form C-8.1B). Instead, you are instructed to issue the provider an Explanation of Benefits / Explanation of Reimbursement (EOB/EOR) that references CARC 16/RARC N34 codes, to indicate the provider’s bill was not submitted electronically. In order to be reimbursed, providers must resubmit any denied bills to payers electronically through an approved electronic submission partner within 120 days from the date medical care was rendered.
COST OFFSET
As a reminder, providers can offset the cost of electronic submission partner by using CPT code 99080 on the CMS-1500 form. No supporting documentation is required for using code 99080. The price entered for this code should reflect the actual cost of electronic submission of the individual bill (based on the provider’s agreement with their chosen electronic submission partner), up to a maximum of one dollar. Payers who do not properly reimburse health care providers for CPT code 99080 may be subject to penalties from the Board. Read more in the June 30, 2025 notice.
What bills are eligible for the offset?
Payers MUST pay the offset to providers for any bill submitted electronically containing code 99080 on or after August 1, 2024.
CMS-1500 WEBINARS
The Board is hosting webinars on electronic submission through July. These one-hour sessions provide an overview of the mandate and include time at the end for participant questions. Visit the Upcoming Webinars section of the website to find a date that works for you.
MORE INFORMATION
Visit wcb.ny.gov/CMS-1500.
The What Payers Need to Know and What Providers Need to Know sections of the Board’s website walk payers and providers through getting started in the workers’ compensation system. Each section also features important updates for payers and providers.
If you have not already done so, be sure to sign up to receive Board news straight to your inbox, including updates on the progress of this initiative, upcoming webinars, and more.
Questions?
Email CMS1500@wcb.ny.gov.
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