Health care providers are a critical partner in helping the injured workers of New York State get better and back to their lives! Here are important resources and requirements for treating health care providers to be aware of regarding the workers' compensation system.
Getting started
The Medical Portal is a web-based application that enables users to submit medical information and view the NYS Workers' Compensation Board (Board) information electronically. The Medical Portal is intended to create more efficient processes and enable greater levels of self-service and tracking, and ultimately improve the performance of New York's workers' compensation system overall.
Health care providers who would like to request or renew Board authorization, or use the Medical Portal to access OnBoard, MTG Lookup Tool, Drug Formulary Lookup Tool, or training will need to request a Board-assigned NY.gov user ID and password. This is separate and apart from any NY.gov account that the health care provider has created for themselves or may have for another NYS agency (for example, Department of Motor Vehicles, Tax and Finance, etc.).
Read more about the Medical Portal for Health Care Providers.
Health care providers who are eligible to become authorized must do so prior to providing clinical services for injured/ill workers. Learn which health care providers can become authorized and how to apply for authorization. Certain providers, such as dentists, are not eligible for Board authorization, but may nevertheless provide clinical services to injured/ill workers. Learn who can do what in the workers' compensation system.
Once authorized, you must renew your Board authorization at intervals which coincide with your professional license registration. Be sure to also update your authorization information whenever there is a change to your address, telephone or fax numbers, board certification status (if applicable) or professional specialty.
Providers authorized by the NYS Workers' Compensation Board to treat injured workers who wish to cease treating injured workers must submit a signed letter of resignation to the Board together with a transition plan to ensure continuity of care for injured workers under their care. Read more about what to include in the letter and where to send it.
Treating injured workers
New York Medical Treatment Guidelines (MTGs)
The Workers' Compensation Board's New York Medical Treatment Guidelines (MTGs) are the standard of care for treating individuals with work-related injuries and illnesses in New York State (NYS) and are based on the best available medical evidence and the consensus of experienced medical professionals.
You can view the current MTGs as well as FAQs and other MTG resources, including training (with CME credit for MDs and DOs), and an easy-to-use MTG Lookup Tool.
New York Workers' Compensation Drug Formulary (Drug Formulary)
Legislation enacted in April 2017 required the NYS Workers' Compensation Board (Board) to establish a drug formulary. The New York Workers' Compensation Drug Formulary (Drug Formulary) is based on a medication's effectiveness and appropriateness for the treatment of illnesses and injuries covered under the Workers' Compensation Law.
The Drug Formulary list designates drugs as either "Phase A," "Phase B," or "Perioperative." Additionally, some drugs are listed as second-line therapy and may only be used when other drugs associated with the phase of treatment have been deemed ineffective or are otherwise determined to be clinically contra-indicated for a particular patient. Drugs not listed on the Drug Formulary are considered non-formulary.
Read more about the New York Workers' Compensation Drug Formulary, including application of the Drug Formulary and special considerations.
Requesting prior authorization for medical treatment/tests through OnBoard
A prior authorization request (PAR) is a request by an injured worker's health care provider to obtain prior approval from the claim administrator (e.g., insurance carrier, self-insured employer, or third-party administrator) to cover costs associated with a specific treatment under workers' compensation insurance. All PARs are submitted and reviewed online through the Board's business information system, OnBoard. Health care providers need to log into the Medical Portal to access OnBoard.
Read more about OnBoard access and administration. Read more about PAR types and how to submit a PAR. Learn more about online administration and how to assign delegate roles for OnBoard by visiting New User Access and Administration for Health Care Providers.
The Board has created OnBoard trainings to assist providers in all aspects of using OnBoard.
Treating via telehealth
Effective July 11, 2023, the Board adopted permanent regulations for telehealth appointments in certain situations for workers who sustain a work-related injury or illness. While telehealth was permitted during the COVID-19 pandemic, it was only allowed because of the institution of several emergency regulations. Now, telehealth is a permanent option within the workers' compensation system. For more information, including which provider specialties can treat via telehealth and under what conditions, see the Telehealth page.
New York State Guidelines for Permanent Impairment and Loss of Wage-Earning Capacity
The Board has published two separate guidance documents (2012 and 2018 ) related to the determination of permanent impairment and/or loss of wage-earning capacity. The Board has created trainings on the NYS Guidelines for Determining Impairment and Loss of Wage-Earning Capacity.
Billing for services
Medical fee schedules
Recent changes to the Board's medical fee schedules have brought workers' compensation rates more in line with other insurances. The Official New York Workers' Compensation Medical Fee Schedule may be purchased from OptumInsight 360 or can be reviewed in person at the Office of the Department of State, 162 Washington Ave., Albany, NY 12231, the Legislative Library, the libraries of the New York State Supreme Court, and the Workers' Compensation Board District Offices.
CMS-1500 Form
The New York State workers' compensation system now uses the universal billing form, CMS-1500, for medical billing. 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. The template includes at the top of the page the three elements to include with most narratives: the patient's work status, causal relationship of the injury to the patient's work activities, and temporary impairment percentage. A medical narrative report may be found legally defective if these elements are missing. However, payers should not use the absence of these three elements as the sole basis for denying reimbursement as there are some instances in which they are not required.
While paper CMS-1500 forms are accepted, the Board strongly recommends electronic submission. Providers are encouraged to partner with a CMS-1500 electronic submission partner who will ensure that the medical bill and narrative attachment are sent and accepted by the correct payer. Read more about the CMS-1500 submission process.
Medical billing issues/Disputes
If an insurance carrier has not paid your bill in full within 45 days of submission, you may be able to request the Board's assistance by filing Form HP-1.0 through OnBoard.
Read more about requesting assistance with unpaid medical bills, filing Enforcement on Failure to Pay Award or Judgment (Form HP-J1), and billing for medical testimony on the Medical Billing Disputes page.
For more information on medical bill disputes, please call (800) 781-2362.
Resources
Webpages
Health care providers
What Providers Need to Know webinars
Join this webinar to learn how we're making it easier for payers to review and process workers' compensation claims. Visit the Upcoming Webinars page for the most recent webinar schedule.
WCB Notifications
To stay informed on important updates from the Board, sign up to receive WCB notifications . This will send Board news straight to your email inbox. You can choose to subscribe for alerts on the topics you care most about.
Provider updates
Deletion of drafted DME PARs with updated HCPCS codes
The new Official New York Workers' Compensation Durable Medical Equipment (DME) Fee Schedule is now in effect. As a result, DME PARs saved in OnBoard as drafts were automatically deleted from the Draft eForms tab if they contained Healthcare Common Procedure Coding System (HCPCS) codes that were updated in the DME Fee Schedule. This step is necessary to prevent errors within the OnBoard application as HCPCS codes are updated.
Any draft DME PARs including HCPCS codes that were recently updated by the new DME Fee Schedule (effective June 28, 2024), were removed from the system on the evening of June 27, 2024.
Read more in a notification dated June 27, 2024 .
Revised inpatient case payment rates for Northern Dutchess Hospital, Vassar Brothers Medical Center, and Putnam Hospital effective January 1, 2020 - December 31, 2023
The Office of Health Insurance Programs (OHIP) has calculated revised inpatient rates of reimbursement as a result of rate appeal numbers 929501, 320201, 929502 and 320202, and 929503 and 320203. The revised rates are for inpatient case payment rates at Northern Dutchess Hospital, Vassar Brothers Medical Center, and Putnam Hospital effective January 1, 2020 - December 31, 2023, processed by OHIP and approved by the New York State Division of the Budget.
Read more in Subject Number 046-1691.
Board targets fall 2024 return of in-person hearings
The Board is pleased to announce that we are targeting a fall 2024 opening for multiple hearing locations/customer service centers across the state.
Read more in a notification dated June 14, 2024 .
Fall conference
The Board is hosting a conference at the Empire State Plaza in Albany, NY on October 18, 2024. This full-day program is targeted to all who have a professional interest in the New York State workers' compensation system. Multiple CLEs and CMEs will be available. Sign up for email/text notifications to receive complete details and registration information in the coming months.
Read more in a notification dated May 1, 2024 .
New maximum weekly benefit rate
The maximum weekly benefit rate will be $1,171.46 for compensable lost time for workers' compensation claims with dates of injury during the period from July 1, 2024, through June 30, 2025.
Read more in Subject Number 046-1678.
Additional criteria for Section 32 Waiver Agreements reviewed without a hearing
Effective July 1, 2024, the Board will utilize a desk review process, as opposed to a formal hearing, to review Section 32 waiver agreements involving claimants who are represented by counsel, in which the gross settlement amount is $10,000.00 or less.
Read more in Subject Number 046-1683.
Reminders
Interested in treating injured workers? If you are interested in applying for Board authorization to treat injured workers, the process is easy and is done online. Read more about becoming authorized here on the Board's website.
The What Providers Need to Know section of the Board's website features a one-stop-shop that walks health care providers through getting started in the workers' compensation system, treating injured workers, billing for services, and more.
Telehealth is now a permanent option in the workers' compensation system. Read more in Subject Number 046-1613.
Use of the CMS-1500 form is mandatory. Visit CMS-1500 initiative for more details and send your questions to CMS-1500@wcb.ny.gov.
Visit the Board's website for OnBoard training guides, webinar recordings, and other resources.
Efficiency Enhancements is a new communication with tips and best practices on using Board systems, processes, and forms in the most efficient, effective manner. Sign up to receive these, and other updates, straight to your inbox.
The Board is hosting free COVID-19 & workers' comp webinars. The Board has been hosting a series of webinars to aid workers with long COVID workers' compensation claims. Additional dates will be added soon!
The latest versions of several Paid Family Leave presentations are now available, including family care, foster care/adoption, military leave, and bonding. Visit the Paid Family Leave website for more information.
Stay Informed!
Check out the Board's Health Care Providers Recorded Webinars web page for past webinars.
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Archived Updates
Contact the Medical Director's Office (MDO)
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