HP-1 Form: Health Provider's Request for Decision on Unpaid Medical Bill(s)
The HP-1 request form should be submitted when the health provider has been unsuccessful in obtaining payment from a carrier for services rendered to a patient who has a Workers' Compensation case. (Please see information below regarding the HP-J1 Form which should be used when a provider has not been paid after an administrative award or administrative decision was made.)
Note: A minimum of 45 days must elapse after submission of the medical bill to the carrier before the HP-1 Form can be submitted. The Board suggests waiting 60 days because some carriers make their payments on that cycle.
There are two choices offered through the disputed bills process. Your choice will depend upon the carrier's response (or lack of response) to your submitted bill(s).
[Box A] Administrative Award is used when an insurance carrier has not responded to your bills with a written objection within 45 days. Your HP-1 request must be received by the Board's Disputed Medical Bill (DMB) Unit within 165 days after you have submitted your bill to the carrier. The health provider must sign the HP-1 and a copy of the bill originally submitted to the insurance carrier must be attached. An Administrative Award is generated based on the established WCB medical fee schedule. The carrier will have an opportunity to respond to this award. The Board will consider that response, and based on evidence provided will either rescind or uphold the award.
[Box B] Arbitration is used when an insurance carrier has responded to your bills with a timely written objection (45 days). Be sure to submit the HP-1 form to DMB within 120 days from the time you receive the carrier's objection. There are two types of arbitration–desk arbitration and panel arbitration.
Disputes involving $1,000 or less are resolved by desk arbitration. Providers seeking arbitration in disputes of greater than $1,000 may elect desk arbitration or panel arbitration. Filing fees for desk and panel arbitrations were eliminated in April, 2015.
HP-J1 Form: Provider's Request for Judgment of Award, Section 54–b, Enforcement on Failure to Pay Award or Judgment
The HP-J1 Form should be submitted when an authorized workers' compensation provider has not been paid for an administrative award or arbitration decision made on or after March 13, 2007. The provider must wait at least 30 days from the issuance of an administrative award and/or arbitration decision before requesting consent for judgment of the award. To avoid the complications of filing unnecessary requests, waiting 60 days is recommended. The 60 day time period will allow for carriers' billing/payment cycles.
Note: The consent to file and certified copy of the decision that awards compensation must be filed with the appropriate county clerk's office within 30 days following the execution of the document.
For more information on the HP processes, please contact Disputedmedicalbills@wcb.ny.gov