Skip to Content

Workers’ Compensation Board

If you are using an Internet Explorer 11 web browser and are having trouble logging into any of the Board's web applications, please refer to these instructions. Login Problems and IE 11

New York State
Workers' Compensation Board
328 State Street  Schenectady, New York 12305
Governor Andrew M. Cuomo

Subject No. 046-1079

Board Announces Technical Specifications
for CMS-1500 Initiative

Date: July 16, 2018

As announced on April 17, 2018, in Subject Number 046-1058 Proposals to Improve Medical Care for Injured Workers, the New York State Workers' Compensation Board (Board) will replace the current Board treatment forms: Doctor's Initial Report (Form C-4), Doctor's Progress Report (Form C-4.2), Occupational/Physical Therapist's Report (Form OT/PT-4), Psychologist's Report (Form PS-4), and Ancillary Medical Report (Form C-AMR) with the CMS-1500 to help reduce paperwork and lower provider administrative burdens. This initiative will leverage providers' current medical billing software and medical records while promoting a more efficient workers' compensation system. It is expected that the initiative will roll out in three phases, as follows:

Phase 1: Commencing January 1, 2019:

  • Providers may voluntarily transmit CMS-1500 medical bills (and required medical narratives, and/or attachments as applicable) through an approved XML Submission Partner ("clearinghouse") to workers' compensation insurers/payers. Guidance on required medical narratives and attachments is available on the Board's website. As previously conveyed in Subject Number 046-785, if a CMS-1500 is submitted without the detailed narrative report or office note, it is not a valid bill submission. A listing of approved clearinghouses for the CMS-1500 will be posted on the XML Forms Submission section of the Board's website after each entity successfully completes testing and executes an XML Submission Partner agreement with the Board.
  • Workers' compensation insurers/payers will accept CMS-1500 medical billing files from clearinghouses and electronically return acknowledgments of receipt of CMS-1500 files. Such acknowledgements (including receipt date) will be forwarded from the clearinghouses back to providers and the Board.
  • The Board will receive CMS-1500 files, narrative attachments and acknowledgements of receipt from clearinghouses in a designated XML format. The CMS-1500 forms and narrative attachments will be combined and displayed in the applicable claimants WCB case folders.

Phase 2: On or about July 1, 2019:

  • Workers' compensation insurers/payers will electronically transmit Explanations of Benefits (EOB) to their clearinghouses upon adjudication of the associated electronic CMS-1500 medical bills. Such EOB data will be forwarded from the clearinghouses back to providers and the Board.
  • The Board will receive EOB data from clearinghouses in a designated XML format.
  • The Board plans to eliminate the requirement for the insurer/payer to file Form C-8.1B or C-8.4 form (to object to full or partial payment of a medical bill) when an EOB for the medical bill was transmitted through the clearinghouse and the Provider may file Health Provider's Request for Decision on Unpaid Medical Billing (Form HP-1) (based on receipt of EOB).

Phase 3: On or about January 1, 2020:

  • Providers will be required to submit electronic CMS-1500 medical bills (and required medical narratives, as applicable) through their clearinghouses to workers' compensation insurers/payers and to receive EOBs back through their clearinghouse.
  • Providers will be required to electronically transmit any disputes for unpaid medical bills to their clearinghouse using the Board-prescribed form. The clearinghouses will electronically transmit medical disputes to the Board in a designated XML format. The Board will eliminate Forms C-4, EC-4, C-4.2, EC-4.2, C-4.1, PS-4, C-4AMR, EC-4AMR, OT/PT-4, EOT/PT4 and EC-4NARR forms. Web submission and XML submission of these forms will no longer be available.
  • The Board will establish a hardship exception process for providers who are unable to meet the mandatory electronic reporting requirements.

Visit the CMS-1500 Initiative section of the website to access technical specifications for the CMS-1500 medical billing and associated acknowledgement data and to find periodic updates.

Please direct questions to


Clarissa M. Rodriguez