Subject Numbers Regarding Health Provider Authorizations

April 16, 2013

On October 31, 2012, the New York State Workers' Compensation Board (WCB) announced the publication of its NYS eClaims Requirement Tables and Implementation Guide in furtherance of the WCB's rollout of eClaims in spring 2013. The WCB has developed new printable transaction reports to allow claim administrators to notify parties by mail, as required by law.

In addition to electronically filing First and Subsequent Reports of Injury (FROI/SROI) to the WCB as indicated in the NY Event Table, claim administrators are required to notify parties of interest via paper mailing. The Event Table indicates when and to whom a paper report must be sent. The insurer is obligated to serve the following upon the claimant and his or her representative: notices of controversy, acceptance, partial denial, and all reports of payments that are required by regulation. Furthermore, Section 110(1) of the Workers' Compensation Law provides that a copy of the employer's report of injury be provided, upon request to the injured worker.

In support of this requirement, the WCB has developed a printable report format of the electronic FROI/SROI filing that contains the information regarding acceptance, partial denial, controversy, and payment of the claim. This report must be mailed to the claimant and the claimant's representative, pursuant to §300.22. Information regarding the generation and mailing requirements for servable paper documents can be found in Section 3.6 of the NYS eClaims Implementation Guide. The WCB will mandate that where any notice is required to be transmitted to a claimant, or his or her attorney, or licensed representative, that the transmission be completed within one business day of electronic filing with the WCB, and that the date such notice is actually mailed or otherwise transmitted shall be the date of transmittal, regardless of when received by the intended recipient. Please note that Section 3.6 includes multiple electronic options for how claim administrators can obtain their FROI/SROI transaction report for each successfully submitted filing, thus, relieving the claim administrator from the burden of manually generating the paper reports. Samples of all FROI/SROI reports can be found on the WCB website.

The WCB continues to work closely with a broad range of stakeholders. As the WCB publishes more information, it will be posted on the eClaims Overview portion of the WCB website.

For more information on the IAIABC Claims EDI Release 3.0 standard, please visit the EDI Implementation Guide section of the IAIABC website at: www.iaiabc.org. Questions related to this announcement can be directed to: eClaims@wcb.ny.gov. For New York specific requirements, implementation schedules, and other resources, please visit the eClaims section of the WCB website (www.wcb.ny.gov). Click the eClaims logo on the WCB home page to access it.