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As part of ongoing effort to streamline the electronic billing process, the New York Workers’ Compensation Board (WCB) notified healthcare providers that they must contract with an XML electronic submission (trading) partner to electronically submit CMS-1500 universal medical billing forms by August 1, 2025.
Upon receiving a bill from a provider, the provider’s trading partner will submit the bill to the payer or payer’s trading partner. The payer (or payer’s trading partner) must then respond to the bill in a timely manner. Once the bill is acknowledged, it must be returned to the provider’s trading partner, who then files a copy of the bill with the WCB. This final stage is expected to simplify payments, create greater accuracy and efficiency, and improve injured workers’ access to timely, quality medical care.
As the WCB continues to tweak various aspects of the project, please keep the following in mind:
The Optum Workers’ Compensation Public Policy and Regulatory Affairs team continues to engage with the WCB as it implements the final stage of the CMS-1500 project. We will continue to communicate any new information to our clients and system stakeholders as it comes forth from the Workers’ Compensation Board. The bottom line is, system stakeholders should be ready to go live with XML electronic bill transmission as of August 1, 2025.
For more information on the CMS-1500 project, including educational materials, FAQs and training webinars, please visit the CMS-1500 section found on the Board’s website.
Additional Optum resources: For more information on these policy developments and others we have been tracking this year, be sure to visit our Legislative and Regulatory Tracker. Bills or regulations can be filtered by insurance line, topic, status and jurisdiction. If you have questions on these or any other public policy developments, please contact our team at OptumWC.PolicyMatters@optum.com. |