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Payer Updates What Payers Need to Know

Payers

July 22, 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.

OnBoard Updates

The first phase of OnBoard, the Board's new business information system, is now 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 the new system 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.

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.

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 .

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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Archived Updates