New York Workers’ Compensation Board releases enhancement details and timeline for new online claims system implementation

The New York Workers’ Compensation Board (WCB) continues the phased development of their new online claims system, called OnBoard, to replace the existing business information system. Full implementation of the OnBoard system is targeted for 2023, with a limited release planned for early 2021. Once fully implemented, the new system will reduce and remove the current paper-driven system and is intended to provide a:

• Central point for all stakeholders to conduct business with the WCB that is intuitive and user-friendly
• Clear, more efficient path through paperless transactions providing users with online access to the information they need while giving injured workers the choice of paper or online submissions
• Foundation for all data, communication and workflow to support the modernization of claims processing through accuracy and quality

FEATURES OF ONBOARD LIMITED RELEASE – SPRING 2021

The spring 2021 limited OnBoard release will contain various system enhancements and requirements including utilizing OnBoard for prior authorization requests for certain medical treatments and unpaid medical bills.

This early phase will allow medical providers to submit Prior Authorization Requests (PAR) for medical care, as well as permit providers to submit a Providers Request for Decision on Unpaid Medical Bill(s) (Form HP-1). At present, there are five types of PARs to communicate various medical information between providers and claims administration:

• Medical Treatment Guideline (MTG) Confirmation Form MG-1 – Attending Doctor's Request for Optional Prior Approval and Carrier's/Employer's Response
• Non-MTG Over $1,000 Form C-4 Auth – Attending Doctor's Request for Authorization and Carrier's Response
• MTG Special Services Form C-4 Auth
• MTG Variance Form MG-2 – Attending Doctor's Request for Approval of Variance and Carrier's Response
• Medication Form DF-L1 – Currently known as Drug Formulary and Provider’s Request For Formulary Prior Authorization and Insurer’s Response

During the first Phase of OnBoard, the WCB will implement two new PARs – for Durable Medical Equipment and for Non-MTG care under $1,000. These two, along with the original five PARs, will be handled electronically through OnBoard.

Additionally, and important to any pharmacy-related treatment, the WCB intends to transfer the Drug Formulary PAR process, currently available through the medical portal, to the OnBoard portal with all other medical PARs.

To support WCB-authorized providers, the WCB is focusing on the early release of digital PARs and the Request for Decision on Unpaid Bills (Form HP-1) as well as building out the end-to-end processing of PARs for early release to providers and insurers.

RECOMMENDATIONS FOR STAKEHOLDERS

During the initial phase of OnBoard development, all impacted stakeholders, including but not limited to Healthcare Providers, Medical Suppliers and Claims Administrators or any other entities providing medical care and medical billing in New York, should plan to engage with the OnBoard system and future requirements.

We urge our clients to involve their internal development teams, any impacted external vendors and Optum to prepare for using OnBoard. We are ready to assist our clients with compliance efforts.

MORE INFORMATION AND TRAINING

For more details about the new system, please access the WCB OnBoard website: http://www.wcb.ny.gov/onboard.

A WCB OnBoard training video is available at: Intro to OnBoard video.

OPTUM EFFORTS

The Optum Public Policy and Regulatory Affairs team will continue to track and communicate developments related to the OnBoard Claims System. Our Regulatory Implementation team is also engaging with impacted lines of business to ensure our full compliance with the new requirements and forms/formats.

Should you have any questions related to this or any regulatory developments, please feel free to contact us at OWCAPolicyMatters@optum.com.