Overview
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.
The Board has developed a training video to show health care providers, and all others who will be using Form CMS-1500, how to use the form and the required narrative reports to bill for their services to workers’ compensation patients.
You can view the video here: CMS-1500 Training Video
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
Recent News
Several XML Submission Partners have been approved for CMS-1500 submissions. View XML Submission Partner Status
January 13, 2021
- The listing of clearinghouses who are testing or approved to become an XML Submission Partner for the CMS-1500 has been updated to include the web address for most submission partners.
- The Claim Adjust Reason Codes (CARCs) and Remittance Advice Remark Codes crosswalk has modified the RARC codes under objection reason #6, added a new objection reason #13 for failure to submit medical bills electronically, and renumbered subsequent objection reasons.
December 14, 2020
- Additional FAQs
- Providers: Questions 12 through 15
- Payers: Questions 10 and 11
September 30, 2020
- New videos available:
September 10, 2020
- FAQ Clarification
- FAQ Clarification on payer acceptance of the CMS-1500.
August 13, 2020
- Additional FAQ
- FAQ clarifies how payers should address the reduction of a bill to align with the Relative Value Unit (RVU) limitations in the Medical Fee Schedule.
July 27, 2020
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Additional FAQ
- FAQ clarifies the correct approach for billing surgical procedures performed by a surgeon and an assistant
- CMS-1500 Examples
June 4, 2020
- Updated Timeline
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FAQs Clarification
- Several FAQs have been updated to reflect the changes in the project timeline
April 23, 2020
March 26, 2020
- Edits to the XML schema for fields 0, 4, 32 and 33
To see earlier announcements, visit the CMS-1500 News page.
