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OnBoard will be temporarily unavailable for scheduled maintenance from 6:00 p.m. ET Thursday, October 6, 2022, through 7:00 a.m. ET Friday, October 7, 2022. Prior authorization requests with a due date of October 6, 2022 will be extended to October 7, 2022.

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Provider Updates What Providers Need to Know

Health Care Providers

September 7, 2022

Use of the CMS-1500 Form is Now Mandatory

Use of the CMS-1500 form is now mandatory, effective July 1, 2022. Please review the June 27, 2022, GovDelivery for more details.

Read more about the CMS-1500 initiative and send your questions to CMS-1500@wcb.ny.gov.

Three Musts for Medical Reports

The Board has created a fact sheet for providers outlining the three pieces of information that must be included on every medical narrative:

These elements must be either at the top of, or prominently displayed on, the medical narrative that accompanies the CMS-1500 form.

Important: If any of these elements are missing or not prominently displayed, the medical narrative report may be found legally defective, which means injured workers may not receive their needed treatment and/or benefits, and you may not be paid. Bills for ancillary services such as radiology, anesthesiology or surgery have unique attachment requirements.

The Board has developed a medical narrative report template that has these elements built in, which can be used to create the medical narrative report.

New 2022 Acute Per Case Inpatient Hospital Rates, Exempt Hospitals, Exempt Units and Detoxification Inpatient Rate

The Office of Health Insurance Programs has calculated rates of reimbursement for the period January 1, 2022, through December 31, 2022, for acute per case inpatient rates, exempt hospitals, exempt units and detoxification inpatient rates.

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 Law, and the Comprehensive Motor Vehicle Insurance Reparations Act.

Read more in Subject Number 046-1530.

OnBoard Updates

OnBoard is now fully live!

Providers and payers are using OnBoard to request and review prior authorization for Medication, Durable Medical Equipment, and Treatment/Testing, and we have hundreds of these prior authorization requests (or PARs) successfully flowing through the system each day.

More than 43,000 providers have registered for OnBoard, and nearly 25,000 delegates have been added. Since OnBoard launched on March 7, 2022, over 182,000 PARs have been filed.

To assist health care providers with OBLR, the Board has compiled useful information, such as training guides, webinar recordings, and other resources.

As you continue to navigate the new system, do not hesitate to reach out if you need assistance.

For any other questions, contact Customer Service at (877) 632-4996.

New/Updated Medical Treatment Guidelines In Effect

In recent months, the Board has adopted more than a dozen new or updated MTGs. These all became effective with Phase Three of OBLR on May 2.

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. Each training carries CME credit for health care providers. There is also a non-CME version of each training for administrative and other non-medical professionals.

Accessing the Medical Portal

To request Board authorization or use the Medical Portal to access training, the MTG Lookup Tool, Drug Formulary Lookup Tool, CMS-1500 form, or OnBoard you will need to request a Board-assigned NY.gov user ID and password. Read more about accessing the Medical Portal on the Board's website.

Telehealth Update

The Chair has adopted, on an emergency basis, amendments to 12 NYCRR 325-1.8, 329-1.3, 329-4.2, 333.2, and 348.2 to continue to allow telemedicine in some circumstances. These amendments supersede the previous emergency telemedicine adoption to keep telemedicine in effect during the regulatory process for the permanent telehealth proposal. You can read more in Subject Number 046-1529.

The Chair has adopted, on an emergency basis, amendments to 12 NYCRR 325-1.8, 329-1.3, 329-4.2, 333.2, and 348.2 to continue to allow telemedicine in some circumstances. These amendments supersede the previous emergency telemedicine adoption to keep telemedicine in effect during the regulatory process for the permanent telehealth proposal. You can read more in Subject Number 046-1529.

Reminder: Changes to Administrative Decisions and Proposed Decisions (Updated January 2020)

Moving forward, objections to Administrative Decisions (ADs) and Proposed Decisions (PDs) must be stated within the space provided on the issued AD or PD and sent to the Board. Read additional details in the GovDelivery dated July 8, 2022 .

Electronic Versions of Forms Updated for Inclusivity Now Available

The Board recently updated several forms to include an "X" designation for those who do not wish to identify as male or female. Gendered pronouns on these forms have also been replaced with gender-neutral pronouns. Read more in the GovDelivery dated July 8, 2022 .

COVID-19 and Workers' Compensation - New Dates Added

Since February, the Board has been hosting a series of webinars to aid workers with long-haul COVID-19 workers' compensation claims. Additional webinar dates are now available!

Visit the Board's COVID-19 web page for additional resources, including downloadable fact sheets you can share with patients.

Paid Family Leave Resources Available

The Board recently made available the latest versions of several Paid Family Leave presentations, including family care, foster care/adoption, military leave, and bonding. Visit the Paid Family Leave website for more information.

New Maximum Weekly Benefit Rate Effective July 1, 2022 The maximum weekly benefit rate is $1,125.46 for compensable lost time for workers' compensation claims with dates of injury during the period from July 1, 2022, through June 30, 2023. Read more in Subject Number 046-1514.

Medical Reporting in Rochester

Subject Number 046-398 "Authorized Provider Shortage in Rochester Area; Temporary Change on Medical Reporting Requirements" issued on January 26, 2010, has been rescinded, effective July 1, 2022.

It provided temporary relief in the method of medical reporting in the Rochester area due to a shortage of available authorized health care providers to treat injured workers. Specifically, authorized health care providers in Monroe, Livingston, Steuben, Allegany, Wyoming, and Ontario counties were allowed to file the CMS-1500 form with a medical narrative, in place of the forms designated by the Chair (the C-4 family of forms).

The CMS-1500 form with medical narrative is now the Chair's designated medical report. Read more in Subject Number 046-1523R.

Not a Board-authorized provider yet? Learn more and apply online!

The Workers' Compensation Board has begun hosting a new webinar series for health care providers who want to learn more about becoming Board-authorized to treat injured workers in the NYS workers' compensation system. If you missed our August session, you can view the slides on our website. Our next session will be held in October - visit the Board's webinar page for information.

If you are interesting in applying for Board authorization, the process is easy and is done online. Read more about becoming authorized here on the Board's website.

Stay Informed!

Check out the Board's Health Care Providers Recorded Webinars web page for past webinars.

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Archived Updates