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.
Important! Electronic submission is required as of August 1, 2025
As of August 1, 2025, the Board is requiring all health care providers in the workers' compensation system — regardless of office size or patient population — to submit the CMS-1500 universal medical billing form electronically through a Board-approved submission partner (also known as XML submission partner). See Subject Number 046-1707.
As of August 1, 2025, the workers' compensation payer can deny payment of services if the CMS-1500 was not submitted through a Board-approved electronic submission partner and the Board will not enforce payment.
Denying paper bills
If payers receive a paper CMS-1500 bill on or after August 1, 2025, do not submit a Notice of Objection to a Payment of a Bill for Treatment Provided (Form C-8.1B). Instead, you are instructed to issue the provider an Explanation of Benefits / Explanation of Reimbursement (EOB/EOR) that references CARC 16/RARC N34 codes, to indicate the provider's bill was not submitted electronically. In order to be reimbursed, providers must resubmit any denied bills to payers electronically through an approved electronic submission partner within 120 days from the date medical care was rendered.
Cost offset
As a reminder, providers can offset the cost of electronic submission partner by using CPT code 99080 on the CMS-1500 form. No supporting documentation is required for using code 99080. The price entered for this code should reflect the actual cost of electronic submission of the individual bill, up to a maximum of one dollar. Payers who do not properly reimburse health care providers for CPT code 99080 may be subject to penalties from the Board. Read more in the June 30, 2025 notice .
CMS-1500 submission process
- As of August 1, 2025, providers are required to partner with a Board-approved electronic submission partner who will ensure that the medical bill and narrative attachment are sent and accepted by the correct payer.
- When partnered with a submission partner, providers do not need to complete a CMS-1500 form but rather submit their bill and narrative attachment to the submission partner.
- 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 submission partner and return electronic acknowledgement of receipt.
- The 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.
Resources
- Payers' Electronic Submission Partner Lookup
- A list of Board-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.
- Requirements
- Payers FAQs
- Electronic Submission Partners
- Fact Sheet
- Recorded Webinars
- Questions can be directed to: CMS1500@wcb.ny.gov