To reduce administrative burden and increase health care provider participation in the workers' compensation system so injured workers' have better access to medical care, the Board made a strategic decision to transition to the CMS-1500 universal billing form. The Board replaced 12 custom forms with the CMS-1500 and its use became mandatory in July 2022.

The CMS-1500 must be submitted with a detailed narrative report to be considered a valid submission. The Board has developed a template providers can use to create the medical narrative report that accompanies provider submissions of the CMS-1500. This template, along with sample CMS-1500 forms by provider type and other resources, is available on the Requirements page.

Important! Electronic submission required by August 1, 2025

Effective August 1, 2025, the Board will require health care providers to submit the CMS-1500 universal medical billing form electronically through a Board-approved electronic submission partner. (See Subject Number 046-1707)

Providers are strongly encouraged to begin submitting the CMS-1500 electronically as soon as possible and should not wait until the August 1 deadline.

Benefits of electronic submission

• Faster bill payments.
• Reduced administrative burden - the electronic submission partner submits the CMS-1500 to the insurer and the Board.
• Increased certainty, including electronic acknowledgement of the insurer's receipt (removing unnecessary duplicate submissions), and confirmation of acceptance/rejection of the bill within seven days.
• Faster identification and correction of technical errors, and quicker resubmission (no waiting until insurer denies the bill).
• No cost or low cost. Providers can bill up to $1.00 per transaction, to offset the cost of electronic transmission using a designated CPT code. See Electronic Submission Cost Offset. Payers who do not reimburse for this code are subject to penalties.

CMS-1500 submission process

• Effective August 1, 2025, providers are required to partner with a clearinghouse (electronic submission partner) who will ensure that the medical bill and narrative attachment are sent and accepted by the correct payer.
• When partnered with an electronic submission partner, providers do not need to complete a CMS-1500 form but rather submit their bill and narrative attachment to the electronic submission partner they have the relationship with in an agreed-upon format. The agreed-upon format can be paper.
• The electronic submission partner will forward the bill and narrative attachment to the workers' compensation payer.
• The payer will accept the CMS-1500 from the electronic submission partner and return electronic acknowledgement of receipt.
• The electronic submission partner will forward the acknowledgement, including receipt date, to the provider.
• Electronic submission partners will transmit, in the designated XML format, the billing data (including the payer's acknowledgement of receipt), and the image of the CMS-1500 forms and narrative attachments to the Board. The CMS-1500 forms and narrative attachments received by the Board will be combined and displayed in the applicable injured workers' WCB case folders.

When CMS-1500 forms are submitted to the Board using the electronic submission process, providers SHOULD NOT mail, fax or email a duplicate paper form to the Board.

Questions can be directed to: CMS1500@wcb.ny.gov

CMS-1500 Webinar for Providers – March 2025: Video

View a recorded version / Slides of our CMS-1500 Provider Q&A webinar.