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CMS-1500 electronic submission is mandatory

Psychologists

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Overview

Psychologists can play an important role in helping New Yorkers recover from work-related injuries and illnesses.

To treat injured workers in the NYS workers' compensation system, psychologists must be authorized by the Board. Read on to learn more.

Looking for a Board-authorized psychologist or other health care provider? Use the Health Care Provider and IME search.

Board authorization

Psychologists must be authorized by the NYS Workers' Compensation Board to treat injured/ill workers. Learn how to get authorized.

A Board-authorized psychologist can:

  • Diagnose and treat clients who have work-related injuries or conditions.
  • Provide opinions on causal relationship (whether the injury or illness is causally related to work).
  • Make determinations for a client's initial and ongoing level of disability.
  • Provide opinions on permanency (the degree to which a client's disability is permanent).

Treatment

Treatment of workers' compensation patients follows standards of care set forth in the New York Medical Treatment Guidelines (MTGs). There are currently 16 MTGs that address the most common injuries and illnesses within the workers' compensation system. Providers have access to an easy-to-use online MTG Lookup tool to check treatment protocols.

Health care providers who wish to provide treatment and medication that fall outside of the MTGs must obtain prior authorization. Health care providers can submit (and check the status of) prior authorization requests (PARs) using the Board's online system, OnBoard.

See: Medical Treatment Guidelines; OnBoard

Telehealth

Psychologists are authorized to provide treatment by telehealth when medically appropriate and subject to the restrictions contained in the regulations.

For psychologists, telehealth is typically permitted for the first and subsequent visits (including group therapy), regardless of the clinical stage of the injured worker's condition.

Remote behavioral health visits may take place when there is no added benefit to in-person services, or when an in-person office visit poses an undue risk or hardship on the injured worker. The treating psychologist must document the reason for use of a remote telehealth visit in the medical narrative portion of their report. Also, see the when in-person visits are required section of the Board's telehealth webpage.

PARs through OnBoard

A PAR is a request by an injured worker's health care provider to obtain prior approval from the claim administrator (e.g., insurance carrier) to cover costs associated with a specific treatment under workers' compensation insurance. There are several categories of treatment that require prior authorization.

Providers must submit all PARs through OnBoard, the Board's online system. OnBoard automatically routes the request to the appropriate claim administrator for review, and providers can track the status of the PAR through their OnBoard dashboard. Psychologists are eligible to submit the following types of PARs:

  • MTG confirmation - confirmation that the proposed treatment(s)/test(s) are based on a correct application of the New York Medical Treatment Guidelines (MTGs); replaces Attending Doctor's Request for Optional Prior Approval and Carrier's/Employer's Response (Form MG-1). Submission of MTG confirmation is optional for health care providers, but response is mandatory for claim administrators.
  • MTG variance - request for treatments/tests that vary from the MTGs; replaces Attending Doctor's Request for Approval of Variance and Carrier's Response (Form MG-2).
  • Non-MTG over $1,000 - request for treatments/tests costing more than $1,000 with no applicable MTGs; replaces Attending Doctor's Request for Authorization and Carrier's Response (Form C-4AUTH)
  • Non-MTG under or = $1,000 - requests for treatment/test costing $1,000 or less with no applicable MTGs.

To learn more about OnBoard and access training on submitting PARs, please visit the OnBoard section of this website.

Billing

Reimbursement for services performed by Board-authorized psychologists is paid in accordance with the New York Workers' Compensation Behavioral Health Fee Schedule. Providers may purchase the fee schedule from RefMed or view in person by appointment at the locations listed in the Where to view section of the Board's Medical Fee Schedules page.

Psychologists and all providers who bill for services in treating injured workers must use the CMS-1500 universal billing form with an accompanying medical narrative. Psychologists may comment on causal relationship, temporary impairment percentage and work status. The bill and medical report must be submitted electronically through a Board-approved electronic submission partner, otherwise the Board will not enforce payment. Visit the CMS-1500 Initiative webpage for information and resources related to the CMS-1500 universal billing form and electronic submission mandate.

Resources

Here are some helpful resources for health care providers in the NYS workers' compensation system.

  • Health care provider webpage: a section of the Board's website specifically for health care providers.
  • Provider Toolkit: important resources, requirements, and updates for treating health care providers to be aware of regarding the workers' compensation system.
  • Training: courses, by topic, including the New York Medical Treatment Guidelines, New York's mandatory standard of care for treatment in the workers' compensation system.
  • OnBoard overview: an introduction to the Board's online system that health care providers use to submit and check the status of prior authorization requests (PARs) for medical treatment and submit requests for review of medical billing disputes.
  • Webinars: the Board regularly hosts webinars for health care providers and other stakeholders, and recordings are posted online. See the Recorded Webinars page to view past webinars or the Upcoming Webinars page to register for a future event.

To get a basic understanding of workers' compensation, it's recommended to view or attend a Workers' Compensation 101 webinar, hosted by the Board's Advocate for Injured Workers.

Contact the MDO

The Board has a Medical Director's Office, who has staff available to answer your questions about treating in the New York State workers' compensation system. You can contact the Medical Director's Office at MDO@wcb.ny.gov or by calling (800) 781-2362.

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