XML forms submission provides an infrastructure to allow the submission of data to the Workers' Compensation Board in an industry-standard format (XML -- Extensible Markup Language). This program is designed to offer the medical community the opportunity to engage in industry standard submission of electronic medical forms to the Workers' Compensation Board. The XML submission program currently supports the submissions of CMS-1500, Doctor's Narrative Report (EC-4NARR), Ancillary Medical Report (EC-AMR) and the Occupational Therapist's/Physical Therapist's Report (OT/PT-4) forms. .
Registered providers may transmit the CMS-1500 form and required medical narratives/attachments in lieu of the EC-4NARR and other WCB medical billing forms, except the Doctor's Report of MMI/Permanent Impairment (C-4.3).
Please Note: It is anticipated that all versions of the C-4 medical billing forms (except the C-4.3) and the OT/PT-4 will be replaced by the CMS-1500 on July 1, 2022. Learn more about the CMS-1500 Initiative.
All health care providers who would like to submit the CMS-1500 using the XML submission process must first complete an online Medical Portal registration and then accept the terms of the legal agreement by selecting the link titled "Agreement for XML submission of CMS-1500," found under the Billing section of the Medical Portal.
Board authorized XML submission partners have proven they comply with the Board's requirements for the electronic submission of these forms and have executed the required legal agreement with the Workers' Compensation Board. The Board posts a list of approved XML submission partners and their contact information if a provider or payer wants to find an XML submission partner who can submit CMS-1500 files on their behalf. Check the list regularly; it is expected that the list may change over time.
Payers must designate with the Board, the XML submission partner(s) from whom they will accept medical bills by October 30, 2021. Payers' Medical Portal Online Administrators must keep XML submission partner information accurate and update the online administrator application with any changes within three (3) business days.
If a medical bill is submitted to the Board using the XML form submission process, DO NOT mail a duplicate paper form to the Board.
The Workers' Compensation Law requires copies to be provided to the claimant, employer, insurance carrier, claimant representative, etc.; it is the health care provider's responsibility to ensure that this reporting requirement is met.