In order to increase health care provider participation in the workers' compensation system and improve injured workers' access to timely, quality medical care, the Workers' Compensation Board (Board) made a strategic decision to transition toward making the CMS-1500 form a required form.

Providers have indicated that the unique paperwork requirements currently in the workers' compensation system are time consuming to complete. To reduce the administrative burden and increase provider participation, the Board will consolidate and eliminate certain medical billing forms and convert to the CMS-1500 form, the universal claim form used by medical providers to bill the Centers for Medicare and Medicaid Services (CMS) as well as health insurers. Careful review and discussion with various stakeholders confirms that the CMS-1500 is easy to use and provides all the necessary information.

The Board will replace the following forms with the CMS-1500:

• Doctor's Initial Report (Forms C-4, EC-4)
• Continuation to Carrier/Employer Billing Section (Form C-4.1)
• Doctor's Progress Report (Forms C-4.2, EC-4.2)
• Ancillary Medical Report (Forms C-4AMR, EC-4AMR)
• Doctor's Narrative Report (Form EC-4NARR)
• Occupational/ Physical Therapist's Report (Forms OT/PT-4, EOT/PT-4)
• Psychologist's Report (Form PS-4)
• Ophthalmologist's Report (Form C-5)

As the CMS-1500 is already used by virtually all medical providers and insurance carriers, the Board anticipates a relatively smooth transition to the CMS-1500. The initiative will leverage providers' current medical billing software and medical records while promoting a more efficient workers' compensation system.

In response to numerous payers’ and health care providers’ questions after the Workers’ Compensation Board’s CMS-1500 training video and webinars held in September 2019, the Board has developed a medical narrative report template that can be used to create the medical narrative report that accompanies provider submissions of the Form CMS-1500. A copy of the template, as well as line-by-line instructions, can be found in the CMS-1500 Requirements page.

Questions can be directed to: CMS1500@wcb.ny.gov