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Workers' Compensation Board

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Medical Portal Frequently Asked Questions


Key Facts

  1. What is the anticipated release date of the Medical Portal? The Project Team has conducted extensive internal testing. Based upon this internal testing and the feedback received from stakeholders, the Board is in the process of making improvements within the Medical Portal. Updates will be posted on the Medical Portal page on the WCB website.
  2. Who will be able to access the first release of the Medical Portal? Payers (insurers, third party administrators, and self-insured employers), health care providers and their staff, injured workers, and attorneys.
  3. What does the first release include? Will it include eBilling? The first release of the Medical Portal will enable electronic submission of C-4AUTH, MG-1, and MG-2 treatment authorization requests. It will provide users with real-time status of requests, and send a notification when a status changes. Users will no longer need to know which form to complete when submitting a request, however they should have a basic knowledge of the Medical Treatment Guidelines. The portal's user interface will ask users questions, the answers to which determine the correct path and type of the treatment authorization request.

    eBilling will not be not included in the first release of the Medical Portal.
  4. Is there a fee associated with registering and accessing the Medical Portal? No, the system is free for registered users.
  5. Are health care providers required to use the Medical Portal to submit treatment authorization requests, or can they still use the paper forms? Health care providers may continue to submit requests using the paper forms, if they choose. It is anticipated, however, that electronic submission will make the approval process faster, reduce errors, improve data quality, and eliminate the need to submit paper authorization forms. Additionally, if a health care provider submits a treatment authorization request electronically, the payer will be required to respond to the request electronically.

    Note: The health care provider should not submit a paper copy of the request if an electronic version was submitted through the Medical Portal and vice versa.
  6. How are health care providers being notified that the Board is implementing the Medical Portal? The Board has and will continue to conduct outreach through various methods, including new website content, WCB Notifications, Subject Numbers, and mailings. All health care providers who anticipate using the Medical Portal are strongly encouraged to register for WCB Notifications or periodically visit the WCB website for updates. Links to the Medical Portal can be found on the Health Care Information, Insurer, Self-Insured Employer and Third Party Administrator web pages.
  7. What are the technical requirements to access the Medical Portal? The Medical Portal is a web-based application and will require Internet access with a compatible browser. The application is compatible with the latest versions of Internet Explorer, Chrome, Firefox, and Safari.

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Registration

  1. How can I register for the Medical Portal? The registration process will be announced on the Board's website and via WCB Notifications. Stakeholders will be given time to register prior to the release of the Medical Portal.

    It is anticipated that injured workers and attorneys will be able to register once and receive access to both the Medical Portal and eCase. It is also anticipated that injured workers and attorneys who are existing eCase users will not need to re-register.
  2. Will the payer's Medical Portal Administrator be the same as eCase? No, it is anticipated the payer will designate an administrator for the Medical Portal as part of the registration process. This will allow organizations to manage access to eCase and the Medical Portal separately for their staff.
  3. Is there a limit to the number of users an organization can enroll? No, there is no limit. A designated administrator(s) for the organization will, however, have the responsibility of removing users who are no longer with the organization or should no longer have access. Prompt removal of a user is important to prevent access to sensitive information that a user should no longer have.
  4. Will a health care provider who practices outside New York be able to register? The first release of the Medical Portal will be available to Board authorized health care providers that practice within New York.

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Training/Webinars

  1. Will the Board continue to offer additional webinars and make training available prior to implementation of the Medical Portal? Yes, the Board will continue with conducting additional webinars. Additionally, prior to implementation of the Medical Portal, the Board will offer training to external stakeholders as well as release a training manual for users.

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Portal Functionality

  1. When the health care provider submits a treatment authorization request, how long before the payer receives the request? The payer will receive the request in real-time if there is a WCB case number associated with the request. If there is no WCB case number associated with the request, the Board will assign one and route it to the payer.
  2. What happens if the health care provider does not know who the payer is on the claim? If the health care provider completes a search against the WCB Claims system and finds a match, the payer information will be returned and flood into the authorization request.

    If there is no match, the health care provider will be able to complete the interview process with the information they have available to them and submit their request. The request will then be routed to the Board, rather than a payer, and the Board will locate the appropriate payer for the claim or assemble a new case if appropriate. After this action has been completed, the Board will route the request to the proper payer on behalf of the health care provider.
  3. How are health care providers notified of responses and reasons for denial of a treatment authorization request? Will they be able to see the payer's notes and any attachments? Health care providers will receive a notification in their Medical Portal queue alerting them to all changes in status. Users can also log in to the Medical Portal at any time and see real-time status of the requests. All users will have the ability to see notes the payer may have made and any conflicting medical attachments the payer uploaded.
  4. How are the injured worker and attorney notified of a payer's response to a treatment authorization request (granted, denied, etc.)? For injured workers and attorneys that are Medical Portal users, a notification will be sent to their respective Medical Portal queues. Status of the treatment authorization request will be updated in real time. The Board will also generate a paper copy of the Treatment Authorization Request response and mail it to the injured worker and attorney on behalf of the payer.
  5. Will the third party administrator be notified of the authorization request when it is submitted by a health care provider? Yes, if the third party administrator is on notice in the case the request will be routed to them directly through the Medical Portal.
  6. Will payers who utilize medical vendors to assist with medical reviews and processing of medical treatment authorization requests have the ability to view treatment authorization requests submitted through the Medical Portal? Yes, the payer will have the ability to add authorized designees of their organization as users.
  7. Is there a method to print a summary of an authorization request that a health care provider submitted through the Medical Portal? For treatment authorization requests that are submitted through the Medical Portal, the Board will generate a Treatment Authorization Request document and mail a paper copy to the injured worker and their attorney for their records. The payer and health care provider will have the ability to retrieve the document from the Medical Portal.
  8. What is the difference between an organizational and individual work queue? Payers and health care providers will have organizational work queues that can be managed by one (or many) supervisors. Treatment authorization requests appear in the organizational work queue to process or assign. Organizational users can view submitted and responded to treatment authorization requests, assign treatment authorization requests (one or more at a time) to individual users, reassign work among individual users, and/or process requests themselves.

    The individual work queue user receives their work based upon assigned work from the organizational user (supervisor) An individual user can view only the requests they are assigned.
  9. Do you need to log in to the Medical Portal to check your work queue? Yes, work items and notifications that are generated when a request is submitted (or responded to) will be viewable within the Medical Portal. The Board is exploring the use of email notifications to support the work item process. A release date for this feature has not been determined.
  10. Will the payer continue to have the ability to specify their preference for either a Medical Arbitrator designated by the Chair or a hearing when denying a variance request? Yes, the payer will continue to have this ability.
  11. What happens if the payer does not respond to the health care provider's authorization request? After the time has expired for the payer to respond to the request, the Board will be notified automatically by the system and take the appropriate action on that authorization request.
  12. Will the parties of interest in a specific case (the payer, health care provider, injured worker, or attorney) see the notes posted related to a treatment authorization request? Yes, notes are visible to all users who are a party of interest to the case and have access to the Medical Portal.
  13. Are the treatment authorization requests time and date stamped by the system? Yes.
  14. Are the columns in the work queue sortable? Yes, most columns within the Medical Portal are sortable.
  15. Will there be an API interface available for health care providers? No, there will be no API interface in the first release of the Medical Portal.

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Documents and Attachments

  1. Which forms does the Medical Portal affect? The Medical Portal will allow health care providers to electronically submit the equivalent of Forms MG-1, MG-2, and C-4AUTH treatment authorization requests.
  2. For health care providers that continue to utilize paper forms, will there be a new authorization form or will they continue to use the existing MG-1, MG-2, and C-4AUTH forms? The Board will continue to utilize the current paper treatment authorization request forms.
  3. Will payers and health care providers be able to obtain paper copies of requests and response documents? Yes, health care providers can print the Treatment Authorization Request and Response documents from the Medical Portal. Payers also have the option of printing copies from eCase.
  4. Will the Board mail copies of the Treatment Authorization Request and Treatment Authorization Response documents to the injured worker and their attorney for the health care providers and payers? Yes, the Board will generate the Treatment Authorization Request and Treatment Authorization Response documents and mail them on behalf of the payer and health care provider.
  5. Are medical reports uploaded into the Medical Portal placed in eCase? Yes, a copy of any document uploaded to the Medical Portal will be placed in eCase. This process occurs nightly, and the documents will be available in eCase the following morning. Registered eCase users will have access to the Medical Portal documents through both the Medical Portal and eCase.

    During the submission process, health care providers can also indicate that a medical report was previously submitted and provide the date of service. This will enable health care providers to submit a request without having to attach a previously submitted medical report, preventing duplicate documents from being placed into eCase.
  6. If a treatment authorization request is submitted by a health care provider on paper form MG-1, MG-2, or C-4AUTH, will the payer respond in the Medical Portal? No, payers must respond to requests submitted on paper forms using the existing procedures for the specific form.

    Note: The health care provider should only submit one request, either in the Medical Portal or on a paper form. A paper request should not be submitted if a treatment authorization request was submitted through the Medical Portal.

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