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Glossary of WCB Terms

 


Diagnostic Testing Networks Look-Up
Frequently Asked Questions

General

  1. What is a Diagnostic Testing Network (DTN)? A DTN is a company that contracts with Board authorized medical providers who have agreed to provide diagnostic tests, such as MRIs, CAT scans, PET scans, and other tests used to diagnose injury or disease. An insurance carrier, third part administrator (TPA), or self-insured employer(SIE) may contract with a DTN and require that all of its injured workers use a DTN to obtain diagnostic testing.
  2. What tests must be obtained through the DTN? This depends on the DTN, but can include MRI, CT, PET, X-ray, and EMG/NCS. The DTN notice (DT-1) identifies the particular tests that must be obtained through the DTN.
  3. Are there any exceptions to the requirement to use a DTN? Yes. An injured worker can obtain a diagnostic test outside of the network if any of the following apply:
    • There is a medical emergency
    • No network provider is within a "reasonable distance" (FAQ 4 below) from the injured worker's home or workplace
    • The DTN cannot perform the test within five days.
    • The carrier or self-insured employer has controverted (denied) the claim and has advised the claimant that it will not pay for diagnostic tests until the case is established..

    In addition, a treating provider may perform an x-ray as part of an office visit in connection with the diagnosis and treatment of fractures, possible fractures, joint dislocations, tumors, infections, loosening of surgical implants, dislocation of prosthetic joints, spinal instability, or follow-up to surgical procedures.
  4. What is a "reasonable distance" for purposes of Question 3? Reasonable distance depends on the location in the state:
    • New York City: 5 miles
    • Albany, Buffalo, Niagara Falls, Rochester, Schenectady, Syracuse, Troy, or Yonkers: 10 miles
    • Nassau, Rockland, Suffolk, and Westchester counties: 15 miles
    • All other locations: 25 miles
  5. What is required of a claim administrator (carrier, TPA, or self-insured employer) that wants to require use of a DTN? The claim administrator must register its use of an authorized DTN with the Board through the Diagnostic Testing Network Registration and update its information within twenty days of any change. It must also comply with all aspects of the Diagnostic Testing Network Regulations, including notifying current claimants within fourteen days of contracting with the DTN, future claimants at the time it sends the statement of rights required under WCL § 110(2), and treating medical providers of the use of the DTN. The notice should be on the DT-1 form or contain substantially equivalent information.
  6. What is required to become a DTN? The requirements to be a DTN can be found in the Diagnostic Testing Network Regulations. Submission of required documentation can be emailed to DTNfiling@wcb.ny.gov

For Injured Workers

  1. How do I know if I need to use a DTN? An injured worker should receive written notification from the claim administrator (carrier, TPA, self-insured employer) or the DTN itself using the DT-1 form or something similar. The notification includes information about how to contact the DTN, the tests that are provided through the DTN, and a statement of rights and responsibilities.
    You may also look up your claim administrator through the Board's Diagnostic Testing Network Look-Up application to determine if your claim administrator requires use of a DTN.
  2. How quickly must the DTN perform my test? The DTN must be able to perform the required test within five (5) days. If the DTN cannot comply with this time frame, the injured worker may go outside of the network to obtain the diagnostic testing.
  3. What happens if I don't receive notification of the DTN? If you don't receive notification through a DT-1 or equivalent form, you may obtain your diagnostic testing from any Board authorized provider.
  4. Can I choose a particular provider within the DTN? Yes. The DTN must provide you with five network providers in your area. You may select any of them or any other provider who is part of the DTN.
  5. If I have to use a DTN, can I still use my regular medical provider to conduct diagnostic tests? Yes, if the provider is part of the DTN or the diagnostic test is covered by an exception to the DTN requirement.

    No, if the provider is not part of the DTN and you have received a DT-1 form/notification letter from your carrier/TPA/SIE informing you of the designated DTN.

For Medical Providers

  1. I am a medical provider, I received a DT-1 form/notification letter from the carrier/TPA/SIE about the use of a DTN, what should I do? You should make note of the DTN requirement for any injured worker covered by this carrier/TPA/SIE and advise the injured worker to contact the DTN to arrange the test. If you refer to or recommend a particular diagnostic testing provider or facility, you should ensure that the provider is part of the DTN listed in the DT-1 form/notification letter.
  2. I am a medical provider, what happens if I do not receive a DT-1 form/notification letter from the carrier/TPA/SIE? The carrier/TPA/SIE is only required to send medical providers a single notice (DT-1), regardless of the number of injured workers who are covered by the carrier/TPA/SIE. However, if you do not receive any DT-1 form/notification, you should be able to perform the diagnostic tests or schedule the tests at a facility of the injured worker's choice
  3. I am a medical provider that can perform diagnostic tests and I did receive a DT-1 form/notification letter, can I still perform the diagnostic tests for the injured worker? If the test is not subject to an exception, you can only perform the diagnostic test if you are part of the DTN. If you are not part of the DTN, you should not perform the diagnostic tests and should inform the injured worker to schedule the diagnostic tests with the DTN listed in the DT-1 form/notification letter.
  4. I am a medical provider and I received a DT-1 form/notification letter. I performed the diagnostic tests anyway because it was convenient for the injured worker. Can I still get paid by the carrier/TPA/SIE? If the carrier/TPA/SIE complied with the notice requirement to the injured worker and no other exception applies, it may refuse to pay you for the test.
  5. I am a medical provider, where do I get a copy of the DT-1 form? The DT-1 form/notification letter is generated by the carrier/TPA/SIE to inform the medical provider and claimant on the use of a designated DTN(s). As a medical provider you do not need to fill-in or produce the DT-1 form.
  6. I am a medical provider, how do I join a DTN network? Each DTN contracts with its own providers. If you are interested in joining a DTN, you can contact the DTN directly to ask about joining the network. List of DTNs serving New York workers' compensation carriers

Questions about the DTN Look-Up Application and Registration

  1. My insurance company has a TPA that administers the claim. Who should I look for in the Board's Diagnostic Testing Network Look-Up application to find out if they have a DTN contract? You should look up the claim administrator – the company who administers your claim and pays your benefits. This is the company that the claim adjuster works for. Generally, if there is a TPA involved, the TPA is the claim administrator.
  2. I am a carrier/TPA/SIE, who has contract with a DTN, how do I provide the WCB with the required information about the use of a designated DTN? The Diagnostic Testing Network Registration page provides information on how to register claim administrator contracts with a DTN. All information should be provided through the online application.
  3. I am a claims administrator or TPA for a(several) carrier(s)/SIE(s) and would like to register the use of a designated DTN on their behalf. How should I proceed? If the carrier(s) or SIE(s) have contracts with the DTN, please contact your client(s) to register through the online application. The carrier/SIE should then note that their claims are administered by the TPA in the comments section of the registration application.
  4. I am a claims administrator or TPA for a(several) carrier(s)/SIE(s). I have contracted with a DTN, to provide testing services for my client(s). How do I provide the WCB with the required information? The Diagnostic Testing Network Registration page provides information on how to register claim administrator contracts with a DTN. All information should be provided through the online application. The claim adminstrator/TPA should then list the client(s) in the comments section of the registration application.
  5. I am an administrator for an Insurance Group, do I need to register for every carrier within my group? No, you can register as an Insurance Group. The Diagnostic Testing Network Look-Up will display all of the carriers on record with the Board as being members of the your group as having a contract with your designated DTN.
  6. I am a carrier/TPA/SIE and I have reviewed the DTN pages, but I still have additional questions – who do I contact? Email your question(s) to DTNfiling@wcb.ny.gov