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Policy Matters Alert

Important legislative and regulatory updates

New York Workers’ Compensation Board Continues Development of the CMS-1500 billing project

February 4, 2025 · Public Policy & Regulatory Affairs Team

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.

Important Specifics

As the WCB continues to tweak various aspects of the project, please keep the following in mind:

Trading Partners

Providers must contract with an electronic trading partner. You can view a list of approved electronic submission partners. Costs and services may vary by company.
Providers can still submit a paper CMS-1500 form to their trading partner, who must then submit the bill electronically.
In order to ensure ease of communication and connectivity, providers and payers should furnish the name and associated information of their selected electronic trading partner to other impacted system stakeholders.

Provider Cost

Providers can offset the cost of using an electronic trading partner by entering code 99080 (a previously utilized “No Charge” code) to seek reimbursement of their actual cost, up to a maximum amount of $1.00. The code should be placed on the same CMS-1500 form requesting payment for billable services.

Submittal Requirements

Payment may be denied when a bill is not submitted electronically through an approved electronic submission partner.
If there are more than six-line items for one date of service, submit multiple CMS-1500 forms together and enter the total charge amount only on the last form.
Providers who are required to use the WCB narrative template to create medical narrative report(s) with the CMS-1500 form are strongly encouraged to do so.
When electronically submitting a CMS-1500 form and narrative, providers should not mail, fax, or email a duplicate bill to the WCB.

Providing Information

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.

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