What Providers Need to Know - Archived Updates

August 11, 2021

Provider Registration and Delegate Assignment Continues for OnBoard: Limited Release

While we prepare for the Board's new business information system, OnBoard, and its early component OnBoard: Limited Release, the Board continues to encourage health care providers to register and assign delegates in preparation for the launch of our new system.

Health care providers must use the Medical Portal to access OnBoard: Limited Release (or to apply for Board authorization) which requires an NY.gov user ID and password for access.

The updated Medical Portal section of the website contains all of the details and information you need regarding how to register and get an NY.gov user ID and password (and grant access to others to act as your delegate) to access OnBoard: Limited Release.

Assigning delegates now will benefit you when OnBoard: Limited Release launches, as delegates can assist you by:

• Drafting prior authorization requests (PARs), which must be reviewed and submitted by the health care provider.
• Drafting escalations to Level 2 Medication PARs, which must be reviewed and submitted by the health care provider.
• Drafting PAR escalations to Level 3 for Medical Director's Office review.
• Responding to insurer requests for information.
• Drafting and submitting Request for Decision on Unpaid Medical Bills (Form HP-1.0).

For additional information, including a walkthrough of the registration process, you can view a video tutorial, check out the provider registration guide or view a recording of the May 11, 2021 webinar for health care providers. You can also view an OnBoard: Limited Release fact sheet and FAQs for providers. Questions? Write to onboard@wcb.ny.gov.

Reminder: Training for Medical Treatment Guidelines Available!

Earlier this summer, the Board launched online training for several newly adopted and updated New York Medical Treatment Guidelines (MTGs) used for diagnosing and treating injured workers. Each training, accessible on the Board's website, provides an overview of the General Guideline Principles, diagnoses associated with the body part or condition, as well as diagnostic and treatment recommendations.

As an added benefit, there is opportunity to obtain up to three complementary continuing medical education (CME) credits upon completion of each course. For those on your staff who would benefit from the training but do not need CME accreditation, non-CME versions of the presentations are available.

To register for the training courses and receive CME credits, go to MTG Training for CME Credit.

For the non-CME training, go to Training for Non-medical and Administrative Staff.

Telemedicine to be Continued

In response to the COVID-19 outbreak in New York State, Board Chair Clarissa M. Rodriguez adopted emergency amendments allowing telemedicine and telephonic visits in some circumstances for safety and social distancing purposes. The Board has since extended these emergency amendments several times. Although most COVID-19 restrictions have recently been lifted in New York State, the success and benefits of telemedicine over the past year has been evident. As such, the Board has renewed the emergency telehealth amendments in the short term, while a new regulation, permanently allowing for telehealth in workers' compensation cases, goes through the regulatory process.

Updates on CMS-1500 Transition

To reduce the administrative burden on Board-authorized health care providers, the Board made the strategic decision to consolidate and eliminate certain medical billing forms and transition to using Form CMS-1500. The following timeline for this transition has recently been updated.

• Phase 1: Voluntary submission (happening now)

  Board-authorized providers may voluntarily transmit CMS-1500 medical bills (and required medical narratives, and/or attachments as applicable) via mail, email, web upload and XML; however, it is recommended that it is done electronically through one of the approved XML submission partners (most commonly known as 'clearinghouses').

• Phase 2: Payers mandated to accept electronic medical bills and Explanation of Benefit / Explanation of Review (EOB/EOR) transmittal (October 1, 2021)

  Payers must electronically accept Form CMS-1500 (can be EDI or other agreed upon format). Payers will be required to identify all legal and valuation objections of payment of the medical bill at the same time and file such objections on Notice of Treatment Issue/Disputed Bill (Form C-8.1) and Notice to Health Care Provider and Injured Worker of a Carrier's Refusal to Pay All (or a portion of) a Medical Bill Due to Valuation Objection(s) (Form C-8.4) within 45 calendar days of acknowledgement of receipt of the medical bill (whether on paper or digital). Payers will electronically transmit EOBs/EORs to their XML submission partners upon adjudication of the associated electronic Form CMS-1500 medical bills.

• Phase 3: Mandatory submission of Form CMS-1500 by providers and payer use of specific Claims Adjustment Reason Codes (CARCs) (July 1, 2022)

  Beginning July 1, 2022, the use of Form CMS-1500 will be mandatory, and electronic submission through a clearinghouse will be strongly encouraged, although not required. Payers be required to use specific Claims Adjustment Reason Codes (CARCs) on their provider EOBs/EORs when objecting to payment of a medical bill.

For more information, visit the CMS-1500 page or write CMS1500@wcb.ny.gov.

Ambulatory Surgery Fee Schedule Update

Chair Clarissa M. Rodriguez has permanently adopted, an amendment to update the Official New York Workers' Compensation Board Ambulatory Surgery Fee Schedule.

For details about this amendment, visit the Regulations page and look under the section titled, Adopted Regulations.

2021 Acute Per Case Inpatient Rates

The New York State Department of Health (DOH) has recently provided the Workers' Compensation Board with acute per case inpatient rates, exempt hospitals, exempt units and detoxification inpatient rates for the period of January 1, 2021, through December 31, 2021. These rates have been calculated for services rendered to patients covered under the Workers' Compensation Law, the Volunteer Firefighters' Benefit Law, the Volunteer Ambulance Workers' Benefit, and the Comprehensive Motor Vehicle Insurance Reparations Act.

For discharges beginning on or after January 1, 2021, the service intensity weights (SIWs), cost thresholds and average length of stay (ALOS) effective July 1, 2018, should continue to be used for payment purposes with the 3M All Patient Refined Diagnosis Related Groups (APR-DRGs) grouper version 34.

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