WHAT PAYERS NEED TO KNOW - ARCHIVED UPDATES
August 31, 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.
Additionally, one of the requirements for payers is that they must provide the Explanation of Benefits (EOBs) electronically to health care providers identifying the same Claim Adjustment Reason Codes (CARCs) as specified on Notice of Objection to a Payment of a Bill for Treatment Provided (Form C-8.1B) or Notice to Health Care Provider and Claimant of an Insurer's Refusal to Pay All (or a portion) of a Medical Bill Due to Valuation Objection(s) (Form C-8.4) when the associated medical bill was received electronically.
You can find more details in GovDelivery dated August 9, 2022 .
Read more about the CMS-1500 initiative and send your questions to CMS-1500@wcb.ny.gov.
OnBoard Updates
OnBoard is now fully live!
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.
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 payers with OnBoard, the Board has compiled useful information, such as training guides, webinar, and other resources.
As you continue to navigate the new system, do not hesitate to reach out if you need assistance.
- Ensure you meet the minimum system requirements to use OBLR.
- For assistance with Medical Portal registration, contact Customer Support at WCBCustomerSupport@wcb.ny.gov.
- For general questions, email OnBoard@wcb.ny.gov.
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.
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.
Reminder: Denials of PARs without a Carrier's Physician Review and Signature are Invalid and Subject to Penalty
As has been mentioned previously, please note that a prior authorization request (PAR) that has advanced to Level 2 review may only be denied by the carrier's physician.
When a payer denies or partially approves a PAR (MTG Variance, MTG Special Services, MTG Confirmation, Medication, Durable Medical Equipment), the payer must also declare any other basis for denial or such basis for denial will be deemed waived.
You can read more in GovDelivery dated July 29, 2022 .
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.
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 .
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.
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.
Stay Informed!
Check out the Board's Payers Recorded Webinars and Guides web page for past webinars.
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