What Providers Need to Know - Archived Updates
November 30, 2021
November Health Care Provider Webinar Replay, Slides Now Available
The Board recently held a webinar for health care providers, providing updates on the Board's many improvement initiatives.
In case you missed it, or if you need a refresher, we have posted a copy of the slide deck on the new Health Care Providers Recorded Webinars section of the Board's website. A recorded version is also available.
For questions on the topics covered, please email MedicalDirectorsOffice@wcb.ny.gov. Do you have a suggestion for a future webinar topic? Send your ideas to email@example.com.
New York Workers' Compensation Drug Formulary Refills and Renewals Compliance
On November 15, 2021, the Chair adopted the New York Workers' Compensation Drug Formulary (Formulary) regulations in 2019, and later amended 12 NYCRR 323.3, to require payers to notify affected injured workers and health care providers that refills and renewals of prescription medication must conform to the Formulary within six months of the effective date of the regulation. Due to the COVID-19 pandemic, the compliance requirement was delayed until June 7, 2021, and payers were instructed to provide a notice to affected injured workers and health care providers on or before April 1, 2021. The Board required another notice be provided on or before May 1, 2021.
Announced via Subject Number 046-1475 on November 15, 2021, the Board has decided the date refills and renewals must comply with the Formulary will coincide with the launch of the first phase of its new business information system, OnBoard: Limited Release (OBLR). Because the timing of the OBLR launch has shifted, the date for concurrent refill and renewal compliance with the Formulary has not yet been established. The Board will announce the rollout date of OBLR, via a WCB Notification email, at least four weeks before launch. Sign up to receive WCB Notifications.
To ensure that treating health care providers and injured workers have adequate notice to prepare for the new compliance date, payers must do the following on or before January 5, 2022:
- Notify health care providers of any injured workers they are currently treating with non-Formulary medications (including the name(s) of the non-formulary medications) so they can either change medications or submit prior authorization requests to continue using the non-Formulary medications; and
- Notify injured workers (claimants) who are currently prescribed non-Formulary medications (including the name(s) of the non-formulary medications) so they can discuss medication options with their treating health care provider.
The notifications must be issued using a format prescribed by the Chair. Please see the Injured Worker Formulary Notification and Provider Formulary Notification for the required format.
Questions? Email Formulary@wcb.ny.gov.
Simultaneous Objections to Medical Bills - Now Required
As referenced in Subject Number 046-1465, the Chair has adopted amendments to 12 NYCRR 325-1.25, effective November 1, 2021, to require all objections to medical bills be made simultaneously to make the process more efficient.
In accordance with the regulation:
- Objections made to medical bills for treatment rendered on or after the regulation's effective date must be made simultaneously.
- If treatment was provided before the regulation's effective date and the insurer previously made an objection to the medical bill, they can file all remaining objections within either the time remaining under the current rules OR within 45 days, whichever is shorter.
- If treatment was provided before the regulation's effective date and no objections to the medical bill have previously been made, the insurer must make all objections simultaneously.
For more information, please email Regulations@wcb.ny.gov.
Revised Doctor's Report of MMI/Permanent Impairment (Form EC-4.3)
The online version of the Doctor's Report of MMI/Permanent Impairment (Form C-4.3) is now available for use, and as communicated on November 5, 2021, both the online and paper versions have been updated. Please be advised of the following changes:
- The billing section has been simplified with space to include information from just one exam.
- Question 5 that asked if the patient would benefit from vocational rehab has been removed from Attachment B.
If you have any questions about the form, please email ImpairmentGuidelines@wcb.ny.gov.
Online Submission of CMS-1500 - XML Agreement Affirmation Requirement
Health care providers must have an XML agreement on file with the Board to submit the CMS-1500 Form online. If no agreement is on file, bills submitted through an XML submission partner will be rejected. The Board has made it easy to accept the agreement:
When you sign in to the Medical Portal on the Board's website, you will be brought to this page. In the Billing section on the right, you will see "Agreement for electronic submission of Form CMS-1500".
When you select "Agreement for electronic submission of Form CMS-1500," a message will pop up that looks like this:
- Select the teal "I Accept" button at the bottom of the agreement. Once you accept the agreement, the link will no longer appear in the Billing section when you sign in again.
Questions? Email CMS1500@wcb.ny.gov.
Emergency Adoption of Amendments to 12 NYCRR 325-1.8, 329-1.3, 329-4.2, 333.2, and 348.2 (Telemedicine)
As communicated via Subject Number 046-1462 on October 13, 2021, 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 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.
A Notice of Emergency Adoption was published in the October 27, 2021, edition of the State Register. This emergency rulemaking became effective as of the filing date on October 12, 2021 and expires 90 days from that date.
New New York Medical Treatment Guidelines (MTGs) Proposed
On October 13, 2021, the Chair proposed an amendment to 12 NYCRR 324.2 to incorporate three new MTGs by reference:
- New York Eye Disorders
- New York Traumatic Brain Injury
- New York Complex Regional Pain Syndrome
The Notice of Proposed Rule Making was published in the October 13, 2021, edition of the State Register. Comments on the revised proposal will be accepted for 60 days after publication. Please submit comments by emailing firstname.lastname@example.org.
For more information, please view Subject Number 046-1460 on the Board's website.
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