New York: 3 Key Narrative Report Requirements
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 CMS-1500. This mandated report is subject to strict state 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 the WCB to help providers adopt this required reporting.
NY Narrative Report Requirements
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 injured workers’ temporary impairment percentage, and
- The injured workers’ work status, and
- The causal relationship of the injury
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 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. Client or not, you can use the pink chat icon in the bottom right of this screen to reach our experts, or email us at info@daisybill.com.
Need a hand making the transition to workers’ comp e-billing? daisyBill is on top of NYS requirements and fee schedules. Learn more and request a demonstration below.
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