June 10, 2022
Subject Number 046-398 "Authorized Provider Shortage in Rochester Area; Temporary Change on Medical Reporting Requirements" issued on January 26. 2010, is hereby rescinded, beginning on July 1, 2022.
The above-referenced Subject Number 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).
For the following reasons, this Subject Number is no longer required and is hereby rescinded:
- The CMS-1500 form with medical narrative is now the Chair's designated medical report. All payers in the workers' compensation system are required to accept the CMS-1500 form with supporting medical narrative from these XML vendors.
- The Expanded Provider Law enacted in 2018 added many new types of health care providers, including: nurse practitioners, physician assistants, licensed clinical social workers, physical therapists, occupational therapists and acupuncturists to the types of providers who may now treat injured workers. The Board's website enables you to search for a health care provider authorized to treat injured workers.
- Doctor's Report of MMI/Permanent Impairment (Form C-4.3) is available in electronic format with drop-down boxes that make the form easy to properly complete.
Accordingly, beginning on July 1, 2022, all medical reports filed by authorized health care providers shall be made on the CMS-1500 form with a supporting medical narrative and submitted by an approved XML submission partner, and reports of maximum medical improvement and permanent impairment shall be submitted on Form C-4.3.
Clarissa M. Rodriguez