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Provider Updates What Providers Need to Know

Health Care Providers

June 22, 2022

OnBoard Updates

OnBoard is now fully live as of May 2.

Today, 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.

Nearly 42,000 providers have registered for OnBoard, and nearly 22,000 delegates have been added. Since OnBoard launched on March 7, 2022, over 107,000 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 Take 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.

New Maximum Weekly Benefit Rate Effective July 1, 2022 The maximum weekly benefit rate will be $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 Beginning July 1, 2022

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Provider Shortage in Rochester Area; Temporary Change on Medical Reporting Requirements" issued on January 26, 2010, is rescinded, beginning on July 1, 2022.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

CMS-1500 Reminders

The July 1, 2022, implementation date for the Board's transition to the CMS-1500 universal medical billing form is quickly approaching, and we want to make sure you are prepared. Please review the April 18, 2022, GovDelivery for more details.

Read more about the CMS-1500 initiative and send your questions to CMS1500@wcb.ny.gov.

Change to Form C-8.4

The Board has made a change to the July 1, 2022, version of the 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) to remove the preferred provider organization (PPO) objection. You can read more in the GovDelivery that was distributed on May 3, 2022.

Medical Narrative Report Template Reminder

Effective July 1, 2022, health care providers are required to include the injured worker's

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.

To ensure the CMS-1500 form is accepted, the Board has developed a medical narrative report template that can be used to create the medical narrative report that accompanies provider submissions of the CMS-1500 form.

Proposed Addition of 12 NYCRR 440.8(c) (Network Pharmacy Notification)

The Chair proposes the addition of section 440.8(c) to Title 12 NYCRR, restoring language requiring insurance carriers to notify pharmacies when there is a network they must use. Read more in Subject Number 046-1525.

Resources on COVID-19 and Workers' Compensation

Since February, the Board has been hosting a series of webinars to aid workers with long-haul COVID-19 workers' compensation claims. You can view the slides and the recorded webinar. Visit the Board's COVID-19 web page for additional resources, including downloadable fact sheets you can share with patients.

Additional webinar dates are now available!

Not a Board-authorized provider yet? Apply online!

Providers are encouraged to apply for Board authorization if you are not already. Becoming a Board-authorized health care provider will allow you to treat and bill for workers' compensation services. Applying 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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