New York State Workers’ Compensation Board sent this bulletin at 07/09/2025 03:00 PM EDT.

The Workers’ Compensation Board (Board) is requiring health care providers to submit the CMS-1500 universal billing form electronically, through a Board-approved electronic submission partner, effective August 1, 2025. Starting that date, the workers’ compensation payer can deny payment of services if the CMS-1500 form was not submitted through a Board-approved electronic submission partner and the Board will not enforce payment.

To ensure uninterrupted payment for your services in treating injured workers, all providers who have not already done so are urged to move to electronic submission as soon as possible. This applies to each individual provider in a practice who treats workers’ compensation patients. 

Several (but not all) of the approved electronic submission partners will accept paper CMS-1500 forms and convert them to electronic on your behalf. If this is something you need, please discuss with your prospective submission partner. If you choose to work with a submission partner that converts paper bills to electronic bills, complying with the Board’s mandate may be as simple as changing the address to where you currently mail your paper bills. If you currently work with a billing clearinghouse, you can contact them to see if they work (or can work) with a Board-approved submission partner.

Please note: When you begin working with an electronic submission partner, you will no longer send your CMS-1500 forms and associated medical narratives to the Board. The electronic submission partner MUST submit the form and narrative on your behalf to both the payer and the Board.

COST OFFSET

Providers can offset the cost of electronic submission by using CPT code 99080 on the CMS-1500 form. The price entered for this code should reflect the actual cost of electronic submission of the individual bill (based on your agreement with your chosen electronic submission partner), up to a maximum of one dollar. When adding code 99080 to the CMS-1500 form, input the last date the patient received services listed on the form (do not use the date of billing). 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.

DENIAL OF PAPER BILLS

If you submit a paper CMS-1500 bill on or after August 1, 2025, the payer will not send you payment Instead, the payer will send an Explanation of Benefits or Explanation of Reimbursement that references CARC 16/RARC N34 codes, which indicates your bill was not submitted electronically. In order to be paid, you MUST resubmit the bill to the payer electronically through an approved electronic submission partner within 120 days from the day medical care was rendered.

CMS-1500 WEBINARS

The Board is hosting webinars on electronic submission through July. These one-hour sessions provide an overview of the mandate and include time at the end for participant questions. Visit the Upcoming Webinars section of the website to find a date that works for you.

MORE INFORMATION

Visit wcb.ny.gov/CMS-1500.

The What Payers Need to Know and What Providers Need to Know sections of the Board’s website walk payers and providers through getting started in the workers’ compensation system. Each section also features important updates for payers and providers.

If you have not already done so, be sure to sign up to receive Board news straight to your inbox, including updates on the progress of this initiative, upcoming webinars, and more.

Questions?

Email CMS1500@wcb.ny.gov.