WHAT PAYERS NEED TO KNOW - ARCHIVED UPDATES
March 17, 2025
Governor Hochul Announces Historic Proposals to Improve Workers' Access to Medical Treatment
In her 2025 State of the State agenda, Governor Kathy Hochul included four legislative proposals and a regulatory change designed to give New York's injured workers more options for timely, high-quality medical care. The Governor's plan would:
- automatically authorize all eligible licensed medical providers, in good standing, to treat injured workers,
- extend authorization to fellow and resident physicians,
- amend NYS Insurance Law and codify a 2006 General Counsel opinion from the Department of Financial Services directing health care insurers to pay for medical treatment for workers' compensation claimants, with no co-pay, while their worker's comp claim is disputed,
- amend the Workers' Compensation Law so workers' compensation insurers can pay for medical treatment, without accepting liability, for up to one year in medical-only cases and
- increase medical fee schedules to be more in line with private insurance.
The majority of these changes would make it easier and better for health care providers to participate in the NYS workers' compensation system, which would give injured workers better access to care.
Read more in the Governor's press release as well this fact sheet that summarizes the proposals.
Enhanced Security Requirements for Accessing eCase
On March 21, 2025, the Board will be implementing multifactor authentication (MFA) for accessing eCase to protect the personal information and accounts of eCase users. MFA is a security mechanism that requires users to provide additional verification information beyond a username and password to gain access to a system, application, or account.
Read more in Subject Number 046-1737.
Improper C-8.1B filings
The Board recently issued new guidance to payers regarding improper filings of the Notice of Objection to a Payment of a Bill for Treatment Provided (Form C-8.1B), which have increasingly become a problem.
Read more in a notification dated January 6, 2025 .
Change in Rate of Reimbursement to Claimants for Travel by Automobile
The rate for personal vehicle mileage on or after January 1, 2025, is 70 cents per mile.
The Board published this rate on January 22, in accordance with the Board resolution adopted on February 20, 1990, that the Board publish the mileage rate for reimbursement to injured workers for travel by automobile on or after January 1st of each year.
Read more in Subject Number 15-18.1.
Proposed Amendments to Sections 440.3, 440.4, and 441.3 and Title 12 of the NYCRR (Network Pharmacies)
The Chair proposes amendments to section 440.3, 440.4, and 441.3 of Title 12 of the NYCRR to provide that a payer must notify the claimant that they may use a non-network pharmacy when the payer maintains (or will maintain) a legal objection that the medication is for treatment of an injury or condition that has not yet been accepted or established by the Board.
Read more in Subject Number 046-1731.
CMS-1500 Electronic Submission Requirement for Health Care Providers
Please be reminded that the Board will require health care providers to contract with an electronic submission partner to submit the CMS-1500 universal medical billing form electronically on their behalf beginning August 1, 2025.
Read more in a notification dated January 7, 2025 .
eCase Document Upload Changes
The eCase document upload feature allows injured workers, payers, and attorneys to upload documents directly to the case folder to use as evidence at scheduled hearings. The document upload feature is not a means to submit claim documents for processing. Once a hearing has concluded, documents can only be filed with the Board via email (wcbclaimsfiling@wcb.ny.gov) or regular mail (P.O. Box 5205, Binghamton, NY 13902-5205). Following this protocol will ensure that documents are promptly addressed by a judge at a hearing or by the Claims unit thereafter.
Read more in a notification dated December 20, 2024 .
ICYMI: New Process for Claimant Information Updates
In case you missed it: The Board has changed the process used to update claimants' information and has implemented a new form, Claimant Name and Address Form (Form OC-966) , to facilitate these requests and ensure the timely delivery of benefits to claimants. Payers should file a FROI/SROI 02 upon receiving this form from a claimant's representative.
Read more in a notification dated December 13, 2024 .
ICYMI: Resolving Employer/Payer Identification Issues: New Process and Guidance to Avoid Delays
A complete Employee Claim (Form C-3) provides essential information about the claim. This is especially important in cases where the proper identity of the employer is at issue. This occurs often in construction cases, where the claimant may be employed by a general contractor, a subcontractor, or work in a general-special employment relationship with multiple employers. Many of these cases face delays and may ultimately become the liability of the Uninsured Employer's Fund (UEF).
Read more in a notification dated November 25, 2024 .
Reminders
Telehealth is now a permanent option in the workers' compensation system. Read more in Subject Number 046-1613.
The What Payers Need to Know section of the Board's website walks payers through getting started in the workers' compensation system, becoming a trading partner, administering claims, and more.
Use of the CMS-1500 form is mandatory. Visit CMS-1500 initiative for more details and send your questions to CMS1500@wcb.ny.gov.
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The latest versions of several Paid Family Leave presentations are available, including family care, foster care/adoption, military leave, and bonding. Visit the Paid Family Leave website for more information.
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