Workers' Compensation Resources for Claims Administrators
To reduce administrative burden and increase health care provider participation in the workers' compensation system so injured workers' have better access to medical care, the Board made a strategic decision to transition to the CMS-1500 universal billing form. The Board replaced 12 custom forms with the CMS-1500 and its use became mandatory in July 2022.
The CMS-1500 must be submitted with a detailed narrative report to be considered a valid submission. The Board has developed a template providers can use to create the medical narrative report that accompanies provider submissions of the CMS-1500. This template, along with sample CMS-1500 forms by provider type and other resources, is available on the Requirements page.
Important! Electronic submission required by August 1, 2025
Effective August 1, 2025, the Board will require health care providers to submit the CMS-1500 universal medical billing form electronically through a Board-approved electronic submission partner. (See Subject Number 046-1707)
If you are not currently working with an electronic submission partner, this fact sheet will guide you through the process step-by-step.
Providers are strongly encouraged to begin submitting the CMS-1500 electronically as soon as possible and should not wait until the August 1 deadline.
Benefits of electronic submission
- Faster bill payments.
- Reduced administrative burden - the electronic submission partner submits the CMS-1500 to the insurer and the Board.
- Increased certainty, including electronic acknowledgement of the insurer's receipt (removing unnecessary duplicate submissions), and confirmation of acceptance/rejection of the bill within seven days.
- Faster identification and correction of technical errors, and quicker resubmission (no waiting until insurer denies the bill).
- No cost or low cost. Providers can bill up to $1.00 per transaction, to offset the cost of electronic transmission using a designated CPT code. See Electronic Submission Cost Offset. Payers who do not reimburse for this code are subject to penalties.
CMS-1500 submission process
- Effective August 1, 2025, providers are required to partner with a clearinghouse (electronic submission partner) who will ensure that the medical bill and narrative attachment are sent and accepted by the correct payer.
- When partnered with an electronic submission partner, providers do not need to complete a CMS-1500 form but rather submit their bill and narrative attachment to the electronic submission partner they have the relationship with in an agreed-upon format. The agreed-upon format can be paper.
- The electronic submission partner will forward the bill and narrative attachment to the workers' compensation payer.
- The payer will accept the CMS-1500 from the electronic submission partner and return electronic acknowledgement of receipt.
- The electronic submission partner will forward the acknowledgement, including receipt date, to the provider.
- Electronic submission partners will transmit, in the designated XML format, the billing data (including the payer's acknowledgement of receipt), and the image of the CMS-1500 forms and narrative attachments to the Board. The CMS-1500 forms and narrative attachments received by the Board will be combined and displayed in the applicable injured workers' WCB case folders.
When CMS-1500 forms are submitted to the Board using the electronic submission process, providers SHOULD NOT mail, fax or email a duplicate paper form to the Board.
The electronic process, prescribed by the Chair, requires payers to partner with at least one Board-approved electronic submission partner to transmit and accept health care provider medical bills via Electronic Data Exchange (EDI), or another format agreed upon with the electronic submission partner.
Payers must designate with the Board the electronic submission partner(s) from whom they accept medical bills. The payers' Medical Portal Online Administrators must keep electronic submission partner information accurate and update the online administrator application with any changes within three (3) business days. Detailed instructions on updating electronic submission partner designations can be found on the Designating an Electronic Submission Partner page.
A list of approved electronic submission partners for the CMS-1500 is posted on the CMS-1500 Electronic Forms Submission section of the Board's website and is updated after each entity successfully completes testing and executes an Electronic Submission Partner Agreement with the Board.
Please contact the WCB Online Services Technical Support Unit if you have technical questions regarding adding an electronic submission partner.
Resources
- Subject Number 046-1362R3 – Important Updates Regarding Forms C-8.1 and C-8.4, Including Implementation Dates Related to the CMS-1500 Initiative
- Requirements
- Payers FAQs
- Electronic Submission Partners
- Questions can be directed to: CMS1500@wcb.ny.gov
- View a video presentation for providers on CMS-1500 and the Expanded Provider Law.