As of July 1, 2022, workers’ comp providers in New York State must bill claims administrators using the universal CMS-1500 billing form (preferably in electronic form, through an approved partner like daisyBill).
Importantly, providers must include a narrative report substantiating the billed charges with the submission of the CCMS-1500. This mandated narrative report is subject to strict NY requirements described below.
As a recent communication from the Workers’ Compensation Board (WCB) reminds providers, failure to meet the narrative report requirements can result in non-payment.
Below are resources provided by New York State WCB to help providers adopt this new narrative reporting when submitting a CMS-1500 for treating an injured worker.
A June GovDelivery bulletin from the WCB highlights a few key requirements for the medical narrative attachment that must accompany every workers’ comp bill. Specifically, all three of the following must be “at the top of, or prominently displayed on” the narrative report:
The WCB bulletin stresses that failure to include the above information as instructed may render the bill submission “legally defective,” and excuse the claims administrator from its obligation to pay.
The bulletin also notes that bills for radiology, anesthesiology, surgery, and other ancillary services have their own unique narrative report requirements.
To help providers create compliant narrative reports, the WCB offers a Medical Report Narrative Template for the CMS-1500, available for download here. Additionally, the WCB offers the slideshow and recording of its recent webinar, “What Providers Need to Know.”
As a state-approved XML submission partner, daisyBill is here to help New York providers stay compliant.
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