This Billing Guide outlines New York’s workers' compensation billing requirements and daisyBill’s resources for filing compliant medical bills.
Billing Form Requirements
This table is a guide to daisyBill's resources on the required forms for compliant paper and electronic workers’ comp billing in New York.
Forms |
Services |
daisyBill Resources |
CMS-1500 |
Physician Services |
|
HP-1 |
Payment Appeal |
|
HP-J1 |
Judgment of Award |
|
UB-04 |
Facility |
*See the CMS-1500 Initiative update
UPDATE: CMS-1500 Initiative
The New York State Workers’ Compensation Board (NYS WCB) has implemented the CMS-1500 Initiative, adopting the form to reduce administrative burden in the workers’ compensation medical billing process for providers. The following forms are to be phased out and replaced with the CMS-1500 Form:
Form |
Name |
Forms C-4, EC-4 |
Doctor's Initial Report |
Form C-4.1 |
Continuation to Carrier/Employer Billing Section |
Forms C-4.2, EC-4.2 |
Doctor's Progress Report |
Forms C-4AMR, EC-4AMR |
Ancillary Medical Report |
Form EC-4NARR |
Doctor's Narrative Report |
Forms OT/PT-4, EOT/PT-4 |
Occupational / Physical Therapist's Report |
Form PS-4 |
Psychologist's Report |
Form C-5 |
Ophthalmologist's Report |
State-Mandated Physician Reporting Requirements
While the WCB phases out the above reporting requirements in favor of the CMS-1500, the Initiative requires a Narrative Report to accompany each CMS-1500 Form. This table is a guide to the Narrative Report requirements for compliant paper and electronic workers’ comp billing in New York.
Service |
Obsolete Requirement |
New Requirement |
Due |
Form / Requirements Link |
Medical Bill |
— |
CMS-1500 & Narrative Report |
Within 90 days of the last day of the month in which services are rendered. |
|
Initial Report |
Doctor's Initial Report |
CMS-1500 & Narrative Report |
Within 48 hours of the first treatment. |
|
Progress Report |
Doctor's Progress Report |
CMS-1500 & Narrative Report |
15 days after the first treatment |
|
MMI Report |
Doctor's Report of MMI / Permanent Impairment |
Doctor's Report of MMI / Permanent Impairment |
When rendering an opinion on MMI and/or permanent impairment; |
|
OT / PT |
Occupational Therapist's / Physical Therapist's Report |
CMS-1500 & Narrative Report |
Within 48 hours of first treatment.
15 days after treatment is first rendered.
At 90 day intervals while continuing treatment. |
|
Ophthalm- ology |
Attending Ophthalmologist's Report |
CMS-1500 & Narrative Report |
Within 48 hours of first treatment.
15 days after treatment is first rendered.
At 90 day intervals while continuing treatment. |
|
Psychology |
Psychologist's Report |
CMS-1500 & Narrative Report |
Within 48 hours of first treatment.
15 days after treatment is first rendered.
At 90 day intervals while continuing treatment. |
Electronic Billing Mandate
Healthcare providers in the state should file their bills electronically. The state of New York has issued electronic billing regulations for medical bills but is currently in transition. Mandatory electronic filing will be effective eventually.
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