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Workers’ Compensation Board

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In order to increase health care provider participation in the workers' compensation system and improve injured workers' access to timely, quality medical care, the Workers' Compensation Board (Board) has made a strategic decision to adopt the CMS-1500 form.

Providers have indicated that the unique paperwork requirements currently in the workers' compensation system are time consuming to complete. To reduce the administrative burden and increase provider participation, the Board will consolidate and eliminate certain medical billing forms and convert to the CMS-1500 form, the universal claim form used by medical providers to bill the Centers for Medicare and Medicaid Services (CMS) as well as health insurers. Careful review and discussion with various stakeholders confirms that the CMS-1500 is easy to use and provides all the necessary information.

The Board will replace the following forms with the CMS-1500:

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

As the CMS-1500 is already used by virtually all medical providers and insurance carriers, the Board anticipates a relatively smooth transition to the CMS-1500. The initiative will leverage providers' current medical billing software and medical records while promoting a more efficient workers' compensation system.

Questions can be directed to:

Recent News

August 6, 2019

The Workers’ Compensation Board has developed a training video to show health care providers, and all others who will be using Form CMS-1500, how to use the form and the required narrative reports to bill for their services to workers’ compensation patients.

You can view the video here: CMS-1500 Training VideoLink to External Website

The Board will also hold two follow-up Q&A webinars so you can get answers to any questions you may have after viewing the training video and reading the CMS-1500 FAQ.

You’re encouraged to view the training video before attending one of the webinars.

The webinars will be held on:

September 17, 2019
8:30 a.m. - 9:30 a.m.
Register for WebinarLink to External Website

September 18, 2019
4:00 p.m. - 5:00 p.m.
Register for WebinarLink to External Website

August 2, 2019

  • Updated FAQs:
    • XML Submission Partners: Question 14
    • Providers: Question 17

August 1, 2019

May 31, 2019

  • Updated FAQs:
    • XML Submission Partners: Question 10
    • Payers: Questions 1 & 5
  • Minor edits to the XML schema were made to remove the document control ID number and add an attachment control number in field 19. Information was added to the CMS-1500 Field Requirements for XML Submission spreadsheet regarding validations that may lead to file or document rejection by the Board.

April 25, 2019

March 29, 2019