Please keep the following in mind:
- Very important: When a WCB case number is available it MUST be populated in field 9A. Failure to do this may result in the CMS-1500 form not being matched with the correct case, resulting in delay of review and payment.
- Providers will still have the ability to submit a paper CMS-1500 form to the electronic submission partner (who will then submit it electronically to the Board on the provider's behalf).
- Enter the information correctly on the CMS-1500 form, including payer and employer detail, as indicated on the Requirements page of the Board's website.
- When the CMS-1500 form and narrative are submitted through an electronic submission partner, providers should not mail, fax, or email a duplicate bill to the Board.
- Payment may be denied when a bill is submitted improperly (i.e., not submitted electronically through an approved electronic submission partner).
- Providers decide which electronic submission partner they want to use. Costs and services may vary by company. View the Board's list of approved electronic submission partners.
- Providers will have the ability to offset the cost of using an electronic submission partner by using code 99080, previously a "No Charge" (NC) code defined in the Official New York Workers' Compensation Medical Fee Schedule as "Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form." Code 99080 may be used as a "By Report" (BR) code, up to a maximum value of one dollar. The code should be placed on the same CMS-1500 form for which the billable services payment and the electronic submission costs are being requested. The amount entered under code 99080 should accurately reflect the actual cost incurred by the provider for the electronic submission of the individual bill, up to a maximum of one dollar. Note: A provider who currently submits a CMS-1500 form electronically via an electronic submission partner can bill to offset the cost.
- When billing for a permanency evaluation, the Doctor's Report of MMI/Permanent Impairment (Form C-4.3) must be attached to the CMS-1500 as the medical narrative. If you send a separate C-4.3 form to the Board, it will be rejected.
- If there are more than six-line items for one date of service, you must submit multiple CMS-1500 forms together with the total charge amount appearing only on the last form.
- Providers who are required/permitted to do so are strongly encouraged to use the narrative template to create the medical narrative report that must be submitted with the CMS-1500 form for ease of locating the essential elements of:
- causal relationship of the injury or illness to the patient's work activities
- patient's work status
- temporary impairment percentage