Blog: Daisy News

New York State workers’ comp billing is in transition. Ultimately, the state will make a full, mandatory switch to e-billing. But before that, starting on January 1, 2019, providers may begin using the universal CMS-1500 billing form.

Like any transition, the switch to the CMS-1500 has its challenges. One portion of the form, in particular, has raised concerns among New York providers: Field 19 for Additional Claim Information.

Here, we explain exactly how to complete this section.

Starting January 1, 2019, New York workers’ comp providers may submit original bills using the CMS 1500 form, rather than New York-specific forms C-4, C-4.2, OT/PT-4, PS-4, and C-AMR. Providers nationwide use the CMS 1500 to bill Medicare and group health plans for professional services.

But while the CMS 1500 is a universal billing form, workers’ comp differs significantly from Medicare and group health. The New York Workers’ Compensation Board (WCB) will therefore impose specific requirements for properly completing this form in a workers’ comp context.

On April 17, 2018, the New York State Workers’ Compensation Board (WCB) announced its intention to improve medical care for injured workers. Board Bulletin Subject No. 046-1058 included proposed changes to the Medical Fee Schedule, a reduction in paperwork, and other enhancements to improve access to quality medical care.