Effective August 1, 2025, all NY providers must file their bills for injured worker treatment electronically (e-billing).
Claims administrators are now required to accept providers’ e-bills and respond with electronic Explanations of Review/Explanations of Benefits.
Providers must also send bill data for every bill to the WCB in the mandatory XML file form, through one of eight WCB-approved XML Submission Partners (which includes daisyBill).
e-Billing for MMI/Permanent Impairment
For e-billing, providers must submit the CMS-1500, not Form C-4.3, as the billing form when rendering a decision on MMI and/or permanent impairment. However, providers must submit Form C-4.3 as the required narrative report accompanying the CMS-1500 bill. Do not submit Form C-4.3 separately from the CMS-1500.
NY Form Replaced by CMS-1500, But Still in Use for Narrative Reporting |
Forms C-4.3: Doctor's Report of MMI / Permanent Impairment |
Stay Up to Date
Subscribe to daisyNews for the latest updates on compliance and best practices now that e-billing is mandatory
SUBSCRIBE TO DAISYNEWS