Workers Compensation 101 Guide (for Medical Professionals)

Are you new to Workers Compensation billing? Are patients injured on the job walking into your practice and you are unsure whether to treat them?

Table of Contents

  • Understanding the Workers; Compensation Claims Process
  • Who Is This Guide For?
  • Registering Your Practice With Workers Compensation Board
  • Complete Required Training
  • Documents To Collect During Patient Intake
  • Get Familiarized With Workers Compensation Forms
  • Medical Treatment Guidelines

Who Is This Guide For?

  • Physicians
  • Chiropractors
  • Podiatrists
  • Psychologists
  • Physical Therapist
  • Occupational Therapists
  • Acupuncturists
  • Nurse Practitioners
  • Physician Assistants
  • Licensed Clinical Social Workers

Registering Your Practice With Workers Compensation Board

In order to treat and bill workers’ compensation cases, you need to apply for authorization from the NYS Workers Compensation Board.

  1. Sign up to use the NYS Workers’ Compensation Board Medical Portal and/or login with the credentials that have been assigned to you;
  2. Complete the required training specific to your profession;
  3. Complete the New Provider Authorization Request online application.

You can begin the process of applying on the Medical Portal with ID. (Make sure not to use your personal ID.)

Complete Required Training

Once you have your Medical Portal login information, you can access the training on the Board’s website.

Lastly, Complete the New Provider Authorization Request.

You will need the following information readily available before you begin to apply:

  • Your individual National Provider Identifier (NPI) – Apply for NPI
  • Mailing and practice address(es)
  • NYS license number(s)
  • Board certification(s), if applicable
  • Certificate of completion of an approved residency program (if you have completed a residency)
  • Disciplinary information
  • Curriculum vitae/resume
  • (Physician Assistants Only) Supervising Physician Affirmation Letter  – this must be completed by your supervising physician and attached to your application

Documents To Collect During Intake

The following documents should be obtained from the patient during the initial evaluation.

  • Job Accident Report
  • C-4 Form
  • Patient’s Identification such as Driver License or Passport or Resident Alien Card

Get Familiarized With Workers Compensation Forms

Download the forms on the Workers Compensation Board website or by clicking on “View” below.

  • C-4 – Doctor’s Initial Report (View)
  • C-4.2 – Doctor’s Progress Report (View)
  • C-4.3 – Doctor’s Report of MMI/Permanent Impairment
  • EC4NARR – Doctor’s Narrative Report
  • EC-4 AMR – Ancillary Medical Report
  • OT/PT4 – Occupational Therapist/Physical Therapist’s Report

These forms may be submitted to New York State Workers’ Compensation Board via fax, email or mail. Return receipt request is important to be able to prove you have submitted the form on time.

Customer Service: 877-632-4996

By Fax: 877-533-0337

By Mail: NYS Workers’ Compensation Board
PO Box 5205
Binghamton, NY 13902-5205

Medical Treatment Guidelines

Workers Compensation treatment follows a rigorous protocol that is determined by the Board. All treatment is outlined in the guidelines.

If you feel that the patient requires deviation from the guidelines, you will need to obtain a Medical Treatment Guideline Variance Request with the insurance carrier.

You should familiarize yourself with the Medical Treatment Guidelines which are available as a FREE PDF on the NYSWCB website.

Tip: You can find information and guidelines in multiple languages on the Board’s website.

Below are convenient links to get you started:

Tip: Here you can find answers to Most Frequently Asked Questions Regarding The Medical Guidelines.

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Getting Answers to Questions

If you have questions about how to get started with Workers’ Compensation billing or have specific questions feel free to reach out to GreenBills. We employ Certified Workers’ Compensation Coders who can answer any of your questions.

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