Health care providers are a critical partner in helping the injured workers of New York State get better and back to their lives! Here are important resources and requirements for treating health care providers to be aware of regarding the workers' compensation system.
Getting started
The Medical Portal is a web-based application that enables users to submit medical information and view the NYS Workers' Compensation Board (Board) information electronically. The Medical Portal is intended to create more efficient processes and enable greater levels of self-service and tracking, and ultimately improve the performance of New York's workers' compensation system overall.
Health care providers who would like to request or renew Board authorization, or use the Medical Portal to access OnBoard, MTG Lookup Tool, Drug Formulary Lookup Tool, or training will need to request a Board-assigned NY.gov user ID and password. This is separate and apart from any NY.gov account that the health care provider has created for themselves or may have for another NYS agency (for example, Department of Motor Vehicles, Tax and Finance, etc.).
Read more about the Medical Portal for Health Care Providers.
Health care providers who are eligible to become authorized must do so prior to providing clinical services for injured/ill workers. Learn which health care providers can become authorized and how to apply for authorization. Certain providers, such as dentists, are not eligible for Board authorization, but may nevertheless provide clinical services to injured/ill workers. Learn who can do what in the workers' compensation system.
Once authorized, you must renew your Board authorization at intervals which coincide with your professional license registration. Be sure to also update your authorization information whenever there is a change to your address, telephone or fax numbers, board certification status (if applicable) or professional specialty.
Providers authorized by the NYS Workers' Compensation Board to treat injured workers who wish to cease treating injured workers must submit a signed letter of resignation to the Board together with a transition plan to ensure continuity of care for injured workers under their care. Read more about what to include in the letter and where to send it.
Treating injured workers
New York Medical Treatment Guidelines (MTGs)
The Workers' Compensation Board's New York Medical Treatment Guidelines (MTGs) are the standard of care for treating individuals with work-related injuries and illnesses in New York State (NYS) and are based on the best available medical evidence and the consensus of experienced medical professionals.
You can view the current MTGs as well as FAQs and other MTG resources, including training (with CME credit for MDs and DOs), and an easy-to-use MTG Lookup Tool.
New York Workers' Compensation Drug Formulary (Drug Formulary)
Legislation enacted in April 2017 required the NYS Workers' Compensation Board (Board) to establish a drug formulary. The New York Workers' Compensation Drug Formulary (Drug Formulary) is based on a medication's effectiveness and appropriateness for the treatment of illnesses and injuries covered under the Workers' Compensation Law.
The Drug Formulary list designates drugs as either "Phase A," "Phase B," or "Perioperative." Additionally, some drugs are listed as second-line therapy and may only be used when other drugs associated with the phase of treatment have been deemed ineffective or are otherwise determined to be clinically contra-indicated for a particular patient. Drugs not listed on the Drug Formulary are considered non-formulary.
Read more about the New York Workers' Compensation Drug Formulary, including application of the Drug Formulary and special considerations.
Requesting prior authorization for medical treatment/tests through OnBoard
A prior authorization request (PAR) is a request by an injured worker's health care provider to obtain prior approval from the claim administrator (e.g., insurance carrier, self-insured employer, or third-party administrator) to cover costs associated with a specific treatment under workers' compensation insurance. All PARs are submitted and reviewed online through the Board's business information system, OnBoard. Health care providers need to log into the Medical Portal to access OnBoard.
Read more about OnBoard access and administration. Read more about PAR types and how to submit a PAR. Learn more about online administration and how to assign delegate roles for OnBoard by visiting New User Access and Administration for Health Care Providers.
The Board has created OnBoard trainings to assist providers in all aspects of using OnBoard.
Treating via telehealth
Effective July 11, 2023, the Board adopted permanent regulations for telehealth appointments in certain situations for workers who sustain a work-related injury or illness. While telehealth was permitted during the COVID-19 pandemic, it was only allowed because of the institution of several emergency regulations. Now, telehealth is a permanent option within the workers' compensation system. For more information, including which provider specialties can treat via telehealth and under what conditions, see the Telehealth page.
New York State Guidelines for Permanent Impairment and Loss of Wage-Earning Capacity
The Board has published two separate guidance documents (2012 and 2018 ) related to the determination of permanent impairment and/or loss of wage-earning capacity. The Board has created trainings on the NYS Guidelines for Determining Impairment and Loss of Wage-Earning Capacity.
Billing for services
Medical fee schedules
Recent changes to the Board's medical fee schedules have brought workers' compensation rates more in line with other insurances. The Official New York Workers' Compensation Medical Fee Schedule may be purchased from OptumInsight 360 or can be reviewed in person at the Office of the Department of State, 162 Washington Ave., Albany, NY 12231, the Legislative Library, the libraries of the New York State Supreme Court, and the Workers' Compensation Board District Offices.
CMS-1500 Form
The New York State workers' compensation system now uses the universal billing form, CMS-1500, for medical billing. The Board has developed a Medical Narrative Report Template that can be used to create the medical narrative report that accompanies provider submissions of the CMS-1500 form. The template includes at the top of the page the three elements to include with most narratives: the patient's work status, causal relationship of the injury to the patient's work activities, and temporary impairment percentage. A medical narrative report may be found legally defective if these elements are missing. However, payers should not use the absence of these three elements as the sole basis for denying reimbursement as there are some instances in which they are not required.
While paper CMS-1500 forms are accepted, the Board strongly recommends electronic submission. Providers are encouraged to partner with a CMS-1500 electronic submission partner who will ensure that the medical bill and narrative attachment are sent and accepted by the correct payer. Read more about the CMS-1500 submission process.
Medical billing issues/Disputes
If an insurance carrier has not paid your bill in full within 45 days of submission, you may be able to request the Board's assistance by filing Form HP-1.0 through OnBoard.
Read more about requesting assistance with unpaid medical bills, filing Enforcement on Failure to Pay Award or Judgment (Form HP-J1), and billing for medical testimony on the Medical Billing Disputes page.
For more information on medical bill disputes, please call (800) 781-2362.
Resources
Webpages
Health care providers
What Providers Need to Know webinars
Join this webinar to learn how we're making it easier for payers to review and process workers' compensation claims. Visit the Upcoming Webinars page for the most recent webinar schedule.
WCB Notifications
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Provider updates
HP-1.0 forms without proper documentation
Effective March 1, 2024, any Request for Decision on Unpaid Medical Bill(s) (Form HP-1.0) submitted to the Board without proper documentation will be rejected.
Read more in a notification dated February 21, 2024 .
OnBoard updates now available
There are new enhancements for health care providers in OnBoard, including delegates having the ability to fully submit a prior authorization request and a new attestation for HP-1.0 forms. The training webpages have been updated to feature these enhancements.
Read more in a notification dated February 8, 2024 .
Level three PAR review backlog reduced to zero!
Since launching the first, limited release of OnBoard in May 2022, the Board has reduced the backlog of level three prior authorization request (PAR) reviews from over 8,000 down to zero! Currently, every level three PAR review is now handled within two to three weeks.
Read more in notification dated January 29, 2024 .
New York State workers compensation minimum weekly benefit rate increases
In accordance with legislation signed into law by Governor Kathy Hochul on September 6, 2023, New York State increased the minimum weekly benefit rate for workers' compensation indemnity benefits effective January 1, 2024.
Read more in Subject Number 046-1649.
Form changes to allow affirmations in lieu of affidavits
Legislation was signed that removes the notarization requirement and allows affirmations to have the same force and effect as affidavits.
Read more in notification dated December 22, 2023 .
Updated disability benefits forms
The Board has posted the updated Notice and Proof of Claim for Disability Benefits (Form DB-450) and the new Notice of Denial of Claim for Disability Benefits (Form DB-DEN) will be available upon request. This conforms to the updated disability benefits regulations that took effect January 1, 2024.
Read more in Subject Number 046-1650.
Board to index every complete case by mid-2024
In order to provide clarity and promote efficient resolution of workers' compensation claims, the Board plans to begin indexing every complete case by mid-2024.
Read more in notification dated December 15, 2023 .
Coming soon - DME Fee Schedule update
The Board plans to propose an update to adjust the Official New York Workers' Compensation Durable Medical Equipment (DME) Fee Schedule and additional codes.
The proposal will be published soon in the State Register and on the Board's website. A Subject Number will be issued when it is published.
Reminders
Interested in treating injured workers? If you are interested in applying for Board authorization to treat injured workers, the process is easy and is done online. Read more about becoming authorized here on the Board's website.
Telehealth is now a permanent option in the workers' compensation system. Read more in Subject Number 046-1613, and see our new telehealth webpage for additional information.
Use of Form CMS-1500 is mandatory. Visit CMS-1500 initiative for more details and send your questions to CMS-1500@wcb.ny.gov.
Visit the Board's website for OnBoard training guides, webinar recordings, and other resources.
The Board is hosting free COVID-19 & workers' comp webinars. The Board has been hosting a series of webinars to aid workers with long COVID workers' compensation claims. Additional dates will be added soon!
The latest versions of several Paid Family Leave presentations are now available, including family care, foster care/adoption, military leave, and bonding. Visit the Paid Family Leave website for more information.
Stay Informed!
Check out the Board's Health Care Providers Recorded Webinars web page for past webinars.
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Archived Updates
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