Medical Billing Changes for New York Workers Compensation Board 2019

Did you know that on April 17, 2018, the New York State Workers Compensation Board announced a proposed increase in reimbursement of providers who treat injured workers? They also intended the adoption of a universal claim form to reduce paperwork in the compensation claim. The Bulletin Board Subject No. 046-1058 included some medical billing changes to the Medical Fee Schedule.

The changes are also proposed towards lowering provider’s administrative burdens and improvements leading to improved access to quality medical care.

This initiative will use the providers’ current medical billing software, records and will promote an efficient workers’ compensation system.

All of the above changes became effective on January 1, 2019.

Here are some of the billing changes that New York workers comp billing professionals can expect this year.

Introduction to New Billing Methods

The New York medical providers shall submit their workers’ comp bills to the payer in an electronic manner. As of July 1, 2019, if providers submit the bill to payer electronically, the payer will have to send the medical provider an electronic explanation of benefit (EOB).

As announced in the proposal, the New York State WCB will also replace all the current treatment forms. The replacements include Form C-4, Form C-4.2, Form C-AMR, CMS-1500, and Form OT/PT-4.

When it comes to CMS-1500, the providers can voluntarily transmit these medical bills with an approved XML submission partner. If you submit it without a detailed narrative report, it will not be considered as a valid bill submission.


It is mandatory for every New York medical provider to submit the worker’s compensation bills electronically to payers. They will not be able to use Form C-4, Form C-AMR, Form C-4.2, CMS-1500, or OT/PT-4.

GreenBills workers’ compensation EMR is already capable of submitting bills electronically.

Checkout our guide on which features your EMR shoudl have.

In case of disputes, the providers are required to submit the documents electronically for unpaid or incorrectly submitted bills. The Board will also have an exceptional process for the ones who are unable to meet the electronic and medical billing changes requirements.

But there is no denying that implementation of e-billing will lead to saving natural and other important resources such as time and money.

All the new introduction and changes might take some time to gain prominence, but once it is done, both payers and providers will get the benefits.

Designed for Workers Compensation medical providers, GreenBills (HIPAA Compliant software) is the first web-based EHR, EMR, and practice management software for no-fault and workers compensation billing. Our software is compatible with electronic (E-billing) billing and eliminates all the manual work.

GreenBills has over 15-years of experience in the industry and can help to reduce the burden of paperwork. Keep up with the latest changes in medical billing, while paving the way for further practice growth. For more details, you can call us at 888-274-3755 or send us an email at cl*****@ge**********.com

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