ASK A QUESTION
Billing Guide

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

CMS-1500 Instructions

HP-1

Payment Appeal

HP-1 Instructions

HP-J1

Judgment of Award

HP-J1 Instructions

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.

Narrative Report Instructions

Initial Report

Doctor's Initial Report

CMS-1500 & Narrative Report

Within 48 hours of the first treatment.

Initial Narrative 

Progress Report

Doctor's Progress Report

CMS-1500 & Narrative Report

15 days after the first treatment

For each follow-up visit scheduled when medically necessary while treatment continues but not more than 90 days apart.

Subsequent Narrative

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;

In response to a request by the WCB to render a decision of MMI and/or permanent impairment.

C-4.3 

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.

OT / PT Narrative

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.

Ophthalmology Narrative

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.

Psychology Narrative

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.

DaisyBill Solution

Stay up-to-date on the latest developments in Workers’ Compensation medical billing by subscribing to DaisyBill’s email list.

SIGN UP FOR EMAILS

Was this article helpful?

Search results for: