February 3, 2022
The Workers’ Compensation Board is in the process of building a new online business information system, OnBoard, which will eventually replace the Board’s legacy paper-based claims systems and the eCase system with a single, web-based platform. OnBoard will provide stakeholders with increased accuracy, paperless transactions and a user-friendly interface for interacting with the Board.
OnBoard: Limited Release, the first phase of OnBoard, will be implemented on March 7, 2022. Payers (insurers, self-insured employers, and third-party administrators) should be aware of some key dates and updates ahead of the phased launch of OnBoard: Limited Release.
OnBoard: Limited Release (OBLR), which will roll out in three phases, is designed to move several key processes for health care providers and insurers from paper to online. This includes the prior authorization request (PAR) process for medication, durable medical equipment, and medical treatment or testing. It also includes the submission of Request for Decision on Unpaid Medical Bill(s) (Form HP-1.0) within OBLR.
The three phases are explained in detail below, but here is a quick look at the implementation schedule:
|One||Medication PAR & Form HP-1.0||March 7, 2022|
|Two||Durable Medical Equipment PAR||April 4, 2022|
|Three||Treatment/Testing PARs||May 2, 2022|
Phase One (3/7/22): Medication PAR & Form HP-1.0
Medication PARs will be used for medication requests (replacing the current New York Workers’ Compensation Drug Formulary [Drug Formulary] prior authorization request process). With the implementation of OnBoard: Limited Release Phase One, medical marijuana will also be requested via a Medication PAR, which will replace the current process using the Attending Doctor’s Request for Approval of Variance and Carrier's Response (Form MG-2).
It is important to note that the current Drug Formulary application within the Medical Portal will not be accessible as of 5 p.m. on Friday, March 4, 2022, but will be available again as “read-only” on March 7, 2022, so that previously approved medication requests may be reviewed. All prior authorization requests that are in progress as of 5 p.m. on March 4, 2022, will be suspended and converted to a Medication PAR within OnBoard: Limited Release. Processing will continue in OBLR as of 7 a.m. on Monday, March 7, 2022.
Refills and renewals of prescription medications must comply with the Drug Formulary as of March 7, 2022, when the OBLR Medication PAR process takes effect. As communicated in Subject Number 046-1408, the effective dates were previously amended to coincide with the launch of OnBoard: Limited Release.
As of March 7, 2022, health care providers will request Board action on unpaid medical bills by submitting Form HP-1.0 online, ensuring accuracy and timely receipt. For now, health care providers will continue to receive administrative and arbitration awards by mail, and the objection and judgement processes will remain paper based. In this first phase, payers will not be affected as the processing of Form HP-1.0 after submission will remain the same.
Phase Two (4/4/22): Durable Medical Equipment (DME) PAR (new)
- DME PARs will be used for requests in accordance with the new Official New York Workers' Compensation Durable Medical Equipment (DME) Fee Schedule.
DME Fee Schedule
The Board's new DME Fee Schedule, which lists the DME that may be supplied to an injured worker when medically necessary and in accordance with the applicable New York Medical Treatment Guidelines (MTGs), becomes effective on April 4, 2022, to coincide with the rollout of the new DME PAR in OnBoard: Limited Release. The Chair adopted a new DME Fee Schedule and PAR processes that were published in the State Register on March 3, 2021. The DME Fee Schedule was later updated on December 22, 2021, and another proposed update was published January 19, 2022. Information regarding all of these adoptions and proposals is available on the Regulations page of the Board's website.
For more information about the DME Fee Schedule and updates, go to the Durable Medical Equipment Fee Schedule page of the Board's website.
Phase Three (5/2/22): Treatment/Testing
The PAR types for treatment/testing will be implemented in Phase Three. OBLR will use the information that health care providers enter to determine which type of PAR needs to be submitted.
- MTG Confirmation PARs will be used to request confirmation from the insurer that the procedure or test is based on a correct application of the MTGs, which was previously done using the Attending Doctor's Request for Optional Prior Approval and Carrier's/Employer's Response (Form MG-1). Note: Prior to the implementation of OBLR, MG-1s were optional for both the provider and the payer. With the implementation of OBLR, MG-1s will continue to be optional for the provider, but if submitted, will be mandatory for the payer.
- MTG Variance PARs will be used to request testing or treatment that varies from the MTGs applicable to the body part or condition being treated, which was previously done using the Attending Doctor's Request for Approval of Variance and Carrier's Response (Form MG-2).
- MTG Special Services PARs will be used to request authorization for special service(s), which was previously done using the Attending Doctor's Request for Authorization and Carrier's Response (Form C-4AUTH). Note: This process will mirror the MTG Variance PAR process, rather than the Non-MTG Over $1,000 PAR process.
- Non-MTG Over $1,000 PARs will be used for requests for treatment costing over $1,000 for non-MTG body parts, which was previously done using the Attending Doctor's Request for Authorization and Carrier's Response (Form C-4AUTH).
- Non-MTG Under or = $1,000 PARs (new) will be used for requests for treatment costing $1,000 or less for non-MTG body parts. This PAR type is optional for the health care provider but, if submitted by the provider, a response in OBLR from the payer is mandatory.
In recent months, the Board has adopted more than a dozen new or updated MTGs. These will all become effective on May 2, 2022, when the remaining PAR types roll out within OnBoard: Limited Release.
The Board has training available on the new and updated MTGs. Each training provides an overview of the General Guideline Principles, diagnoses associated with the body part or condition, as well as diagnostic and treatment recommendations.
Information for Payers
Current C-4AUTH, HP-1, MG-1 and MG-2 Forms
The C-4AUTH, HP-1, MG-1 and MG-2 forms will become obsolete with the implementation of OBLR and new requests from providers will not be accepted after the launch date of the corresponding functionality in the system. For Form HP-1, that date is March 7, 2022, and for the C-4AUTH, MG-1 and MG-2 forms, that date is May 2, 2022.
Payer responses to C-4AUTH, MG-1 and MG-2 forms submitted prior to May 2, 2022, will continue to be accepted and those requests will follow the existing process.
Providers should not submit Medication and/or DME PARs with other medical requests on paper forms. If the Board identifies an improper submission, it will not be moved forward.
Request for Further Action (RFA) Forms
The Board will start accepting the new version of the Request for Further Action by Insurer/Employer (Form RFA-2) on May 2, 2022. Use will become mandatory on June 6, 2022.
How to Prepare
Payers can take steps now to prepare for OnBoard: Limited Release, including:
- Review OBLR resources at wcb.ny.gov/onboard to identify potential impacts to existing optional prior approval and variance request processes (Form MG-1 and Form MG-2). It is important to note, payers are required to review and respond to all PAR submissions in OnBoard: Limited Release. This includes the MTG Confirmation PAR (formerly the Form MG-1 process, which will no longer be optional for insurers).
- As communicated in Subject Number 046-1387, payers were required to designate contacts to review and respond to PARs by May 1, 2021. For information about these roles, and how to assign them, see the registration guide for payers at wcb.ny.gov/onboard.
- Modify current processes to align with the new system, particularly the PAR dashboard and PAR email notifications, which alert insurers of important PAR status updates.
- Begin planning for staff training and administrative support.
- Take the training for the new Medication PAR process found at wcb.ny.gov/onboard. Training on the other PARs will be available before Phases Two and Three roll out.
Payers with access to the Medical Portal for Drug Formulary prior authorizations will automatically have access to OnBoard: Limited Release, a second registration is not required. For information about how to update notification emails and assign roles, go to the Medical Portal information page (wcb.ny.gov/medicalportal/), then select Access and Administration under Payers.
Payers may designate Pharmacy Benefit Managers (PBMs) to review Level 1 Medication PARs; however, the PBM must be registered before the payer can designate them as a reviewer. PBMs with access to the Medical Portal are automatically registered for OnBoard: Limited Release. PBMs that are not registered for the Medical Portal must complete the online PBM Medical Portal Registration process. If a payer has a PBM, they must provide the PBM’s email to be notified about decisions, including when an Order of the Chair is issued.
Payers may designate a Medical Review Organization (MRO) to review Level 1 and/or Level 2 PARs; however, the MRO must first complete the online Medical Review Organization Medical Portal Registration process.
The Board has a number of resources available to keep payers informed about OnBoard: Limited Release and answer questions:
- A registration guide for payers, PBMs and MROs, as well as an insurer-specific fact sheet, training, and other information about OnBoard: Limited Release is available at wcb.ny.gov/onboard.
- Training information will be shared via WCB Notifications. Sign up to receive these updates and others at wcb.ny.gov/onboard/#get-involved.
- Sign up for additional notifications related to the Board, such as Subject Numbers, at wcb.ny.gov/Notify.
- For assistance registering for the Medical Portal, contact Customer Support at WCBCustomerSupport@wcb.ny.gov.
- For questions about the MTGs, contact the Medical Director’s Office at WCBMedicalDirectorsOffice@wcb.ny.gov
- For general questions about the OnBoard project, email OnBoard@wcb.ny.gov.
- For any other questions, contact Customer Service at (877) 632-4996.
Clarissa M. Rodriguez