WHAT PAYERS NEED TO KNOW - ARCHIVED UPDATES
December 2, 2024
Improper C-8.1B filings
The NYS Workers' Compensation Board (Board) is issuing 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 .
Paid Family Leave updates for 2025
Both the maximum weekly benefit and the employee contribution rate are increasing for NYS Paid Family Leave starting January 1, 2025. See the Chair's recent announcement and the 2025 Updates page on the PFL website for full details and resources you can share with your policy holders.
Implementation of electronic submission of Request for Further Action by Legal Counsel (Form RFA-1LC) effective December 13, 2024
As announced in the November 2, 2023, Subject Number 046-1636 and June 27, 2024, GovDelivery , the Board is implementing electronic submission of the Request for Further Action by Legal Counsel (Form RFA-1LC).
Effective December 13, 2024, the Board will not accept or act on paper RFA-1LC forms submitted by attorneys/representatives. Additionally, the Board's current legacy RFA-1LC web form will also become obsolete.
Read more in Subject Number 046-1726.
Treatment ZIP Code added to Request for Decision on Unpaid Medical Bill(s) (Form HP-1.0)
To ensure Form HP-1.0 submissions are routed correctly to the Board, a new form field has been added. Providers and their delegates will now enter the ZIP Code of the location where the injured worker was treated.
Read more in a notification dated November 14, 2024 .
Reminder: CMS-1500 submission requirement
As was announced in a notification dated August 1, 2024, 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 in 2025.
Read more in a notification dated November 1, 2024 .
NYS Workers' Compensation Board Announces 2025 Assessment Rate
Pursuant to WCL §151, the Chair of the Workers' Compensation Board shall annually establish an assessment rate for all employers by November 1 of each year, to be effective January 1 of the subsequent calendar year. For calendar year 2025, the rate shall be 7.1% of the standard premium or premium equivalent.
Read more in Subject Number 046-1723.
Enhanced desk review process for Section 32 waiver agreements, effective January 2025
On May 1, 2024, the Board issued Subject Number 046-1683, which announced that beginning July 1, 2024, the Board would review administratively, via the desk review process, all Section 32 waiver agreements of represented claimants in which the gross settlement amount is $10,000 or less.
The Board is now expanding the reach of desk review to include all Section 32 waiver agreements of represented claimants in which the gross settlement amount is $25,000 or less, starting with agreements dated on or after January 6, 2025.
This Subject Number also announced the Board's decision to prospectively review all indemnity-only WCL Section 32 waiver agreements via desk review, and those agreements in which all parties specifically request desk review.
Read more in a notification dated October 23, 2024 .
Individuals may be eligible for 9/11 assistance
Individuals may be eligible for no-cost healthcare and/or financial compensation from the federal government if they were in the areas impacted by the attacks on September 11, 2001, or in the months that followed.
Read more in a notification dated November 8, 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 for billing of medical treatment is mandatory. Visit CMS-1500 initiative for more details and send your questions to CMS1500@wcb.ny.gov.
Visit the Board's website for OnBoard training guides, webinar recordings, and other resources.
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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.
Stay Informed!
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