Providers must submit bills within 120 days or risk losing the right to payment.
Below are the New York Workers’ Compensation Board (WCB) timely filing requirements.
Timely Filing Rules
As of August 1, 2025, authorized providers must submit all medical bills electronically through one of six ‘Electronic Submission Partners’ that meet the WCB’s performance standards.
Providers and hospitals must submit all bills within 120 days from the date of service.
The payer is under no obligation to send reimbursement for non-electronic bills submitted after August 1, 2025.
Instead, the payer can send an Explanation of Review/Benefits (EOR/EOB) that indicates your practice sent the bill non-electronically. From there, you have 120 days from the date of service to resubmit the bill electronically for payment.
When Timely Filing Applies
The 120-day deadline applies to all bills for treatment rendered by WCB-authorized providers, including physicians, chiropractors, physical therapists, occupational therapists, acupuncturists, and others legally permitted to provide care.
Exceptions
If a bill cannot be filed on time, providers may apply in writing to the WCB Chair. The Chair may excuse late filing for good cause.
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Subsection Text |
325-1.25 (b) (1) Physicians, podiatrists, chiropractors, psychologists, nurse practitioners, physician assistants, licensed clinical social workers, physical therapists, occupational therapists and acupuncturists authorized by the chair to provide treatment and care under the Workers’ Compensation Law to a claimant or other legally permitted providers of medical care shall submit bills for medical care in the format prescribed by the chair (which may be electronic) and as set forth in section 325-1.3 of this Subpart. Bills shall be submitted to the employer or insurance carrier (or third-party administrator) within 120 days from the day the medical care was rendered. Bills submitted in any other format or outside this time requirement shall not be eligible for an award by the chair under the provisions of the Workers’ Compensation Law as described herein. When medical care was rendered prior to January 1, 2020, the bill for such care shall be submitted within 120 days from January 1, 2020 (April 30, 2020). (2) Hospitals shall submit bills for out-patient hospital services to the employer or insurance carrier (or third-party administrator) using the New York State Universal Data Set specification as described in 10 NYCRR section 400.18 and Appendices C-2 and C-3 and such additional specifications as are approved by the Commissioner of Health. Bills shall be submitted within 120 days from the last day of medical care. Bills submitted in any other format or outside this time requirement shall not be eligible for an award by the Chair under the provisions of the Workers’ Compensation Law as described herein. (3) Notwithstanding the foregoing, upon an application in writing to the chair, the chair may for good cause shown excuse a delay in the submission of the bill to the insurance carrier or employer (or third-party administrator). |
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