February 3, 2022
The Workers’ Compensation Board is in the process of building a new online business information system, OnBoard, which will eventually replace the Board’s legacy paper-based claims systems and the eCase system with a single, web-based platform. OnBoard will provide stakeholders with increased accuracy, paperless transactions and a user-friendly interface for interacting with the Board.
OnBoard: Limited Release, the first phase of OnBoard, will be implemented March 7, 2022. Health care providers should be aware of some key dates and updates ahead of the phased launch of OnBoard: Limited Release. Please share this information with any medical suppliers you use.
OnBoard: Limited Release (OBLR), which will roll out in three phases, is designed to move several key processes for health care providers and insurers from paper to online. This includes the prior authorization request (PAR) process for medication, durable medical equipment, and medical treatment or testing. It also includes the submission of Request for Decision on Unpaid Medical Bill(s) (Form HP-1.0) within OBLR.
The three phases are explained in detail below, but here is a quick look at the implementation schedule:
|One||Medication PAR & Form HP-1.0||March 7, 2022|
|Two||Durable Medical Equipment PAR||April 4, 2022|
|Three||Treatment/Testing PARs||May 2, 2022|
Phase One (3/7/22): Medication PAR & Form HP-1.0
- Medication PARs will be used for medication requests (replacing the current New York Workers’ Compensation Drug Formulary [Drug Formulary] prior authorization request process). With the implementation of OnBoard: Limited Release Phase One, medical marijuana will also be requested via a Medication PAR, which will replace the current process using the Attending Doctor’s Request for Approval of Variance and Carrier's Response (Form MG-2).
It is important to note that the current Drug Formulary application within the Medical Portal will not be accessible as of 5 p.m. on Friday, March 4, 2022, but will be available again as “read-only” on March 7, 2022, so that previously approved medication requests may be reviewed. All prior authorization requests that are in progress as of 5 p.m. on March 4, 2022, will be suspended and converted to a Medication PAR within OnBoard: Limited Release. Processing will continue in OBLR as of 7 a.m. on Monday, March 7, 2022.
Refills and renewals of prescription medications must comply with the Drug Formulary as of March 7, 2022, when the OBLR Medication PAR process takes effect. As communicated in Subject Number 046-1408, the effective dates were previously amended to coincide with the launch of OnBoard: Limited Release.
As of March 7, 2022, health care providers will request Board action on unpaid medical bills by submitting Form HP-1.0 online, ensuring accuracy and timely receipt. For now, health care providers will continue to receive administrative and arbitration awards by mail, and the objection and judgement processes will remain paper based.
Phase Two (4/4/22): Durable Medical Equipment (DME) PAR (new)
- DME PARs will be used for requests in accordance with the new Official New York Workers’ Compensation Durable Medical Equipment (DME) Fee Schedule.
DME Fee Schedule
The Board’s new DME Fee Schedule, which lists the DME that may be supplied to an injured worker when medically necessary and in accordance with the applicable New York Medical Treatment Guidelines (MTGs), becomes effective on April 4, 2022, to coincide with the rollout of the new DME PAR in OnBoard: Limited Release. The Chair adopted a new DME Fee Schedule and PAR processes that were published in the State Register on March 3, 2021. The DME Fee Schedule was later updated on December 22, 2021 and another proposed update was published January 19, 2022. Information regarding all of these adoptions and proposals is available on the Regulations page of the Board's website.
Some items on the DME Fee Schedule require prior authorization and are marked as “PAR”; the treating provider will need to request prior authorization for these items. Any item not on the DME Fee Schedule also requires prior authorization by the provider. DME suppliers are not able to request prior authorization. Detailed information is available in the DME supplier fact sheet at wcb.ny.gov/onboard.
For more information about the DME Fee Schedule and updates, go to the Durable Medical Equipment Fee Schedule page of the Board’s website.
Phase Three (5/2/22): Treatment/Testing
The PAR types for treatment/testing will be implemented in Phase Three. OBLR will use the information that health care providers enter to determine which type of PAR needs to be submitted.
- MTG Confirmation PARs will be used to request confirmation from the insurer that the procedure or test is based on a correct application of the MTGs, which was previously done using the Attending Doctor’s Request for Optional Prior Approval and Carrier’s/Employer’s Response (Form MG-1). Note: Prior to the implementation of OBLR, MG-1s were optional for both the provider and the payer. With the implementation of OBLR, MG-1s will continue to be optional for the provider, but if submitted, will be mandatory for the payer.
- MTG Variance PARs will be used to request testing or treatment that varies from the MTGs applicable to the body part or condition being treated, which was previously done using the Attending Doctor’s Request for Approval of Variance and Carrier's Response (Form MG-2).
- MTG Special Services PARs will be used to request authorization for special service(s), which was previously done using the Attending Doctor’s Request for Authorization and Carrier’s Response (Form C-4AUTH). Note: This process will mirror the MTG Variance PAR process, rather than the Non-MTG Over $1,000 PAR process.
- Non-MTG Over $1,000 PARs will be used for requests for treatment costing over $1,000 for non-MTG body parts, which was previously done using the Attending Doctor’s Request for Authorization and Carrier’s Response (Form C-4AUTH).
- Non-MTG Under or = $1,000 PARs (new) will be used for requests for treatment costing $1,000 or less for non-MTG body parts. This PAR type is optional for the health care provider, but a response from the payer is mandatory.
In recent months, the Board has adopted more than a dozen new or updated MTGs. These will all become effective on May 2, 2022, when the remaining PAR types roll out within OnBoard: Limited Release.
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 and carries CME credit for the provider.
To register for the training courses and receive CME credits, go to MTG Training for CME Credit.
For the non-CME training, go to Training for Non-medical and Administrative Staff.
Information for Health Care Providers
The C-4AUTH, HP-1, MG-1 and MG-2 forms will become obsolete with the implementation of OBLR and will not be accepted after the launch date of the corresponding functionality in the system. For Form HP-1, that date is March 7, 2022, and for the C-4AUTH, MG-1 and MG-2 forms, that date is May 2, 2022. Payer responses to C-4AUTH, MG-1 and MG-2 forms submitted prior to May 2, 2022, will continue to be accepted and those requests will follow the existing process.
Providers should not submit Medication and/or DME PARs with other medical requests on paper forms. If the Board identifies an improper submission, it will not be moved forward.
How to Prepare
Health care providers can take steps now to prepare for OnBoard: Limited Release, including:
- Review OBLR resources at wcb.ny.gov/onboard to identify potential impacts to existing optional prior approval and variance request processes (Form MG-1 and Form MG-2).
- Assign delegates who can be authorized to assist with the drafting of PARs for the health care provider, and the drafting and submission of Form HP-1.0.
- Modify current processes to align with the new system, particularly the PAR dashboard and PAR email notifications.
- Begin planning for staff training and administrative support.
- Take the training for the new Medication PAR and/or Form HP-1.0 processes found at wcb.ny.gov/onboard. Training on the other PARs will be available before Phases Two and Three roll out.
Health Care Provider Registration
Providers will need access to the Board’s Medical Portal to submit PARs and Form HP-1.0 through OnBoard: Limited Release. Providers who currently have access to the Medical Portal will automatically be granted access to OnBoard: Limited Release using the same login credentials. This will enable health care providers to add delegated users to assist with the drafting of PARs and Form HP-1.0 submissions. Delegates can submit Form HP-1.0, draft PARs and respond to PAR-specific inquiries for providers, however, only the treating provider can submit a PAR.
Health care providers whose specialty is not listed in the Who Can Do What in the Medical Portal table and who need access to OnBoard: Limited Release to submit Form HP-1.0 will need to request access to the Medical Portal as a medical supplier. Detailed information about assigning delegated users and requesting access as a medical supplier is available on the Medical Portal information page (wcb.ny.gov/medicalportal/). Select the Access and Administration links under Health Care Providers and Medical Suppliers.
The Board has a number of resources available to keep health care providers informed about OnBoard: Limited Release and answer questions:
- A provider-specific registration guide, fact sheet, training and other information about OnBoard: Limited Release is available at wcb.ny.gov/onboard.
- Training information will be shared via WCB Notifications. Sign up to receive these updates and others at wcb.ny.gov/onboard/#get-involved.
- Sign up for additional notifications related to the Board, such as Subject Numbers, at wcb.ny.gov/Notify.
- For assistance registering for the Medical Portal, contact Customer Support at WCBCustomerSupport@wcb.ny.gov.
- For questions about the MTGs, contact the Medical Director’s Office at WCBMedicalDirectorsOffice@wcb.ny.gov
- For general questions about the OnBoard project, email OnBoard@wcb.ny.gov.
- For any other questions, contact Customer Service at (877) 632-4996.
Clarissa M. Rodriguez