The coronavirus pandemic has presented employers, workers’ compensation insurers, and third-party administrators with unprecedented challenges—both from a regulatory and statutory standpoint and from the incidence of novel claims for alleged coronavirus-related injuries. Goldberg Segalla’s Workers’ Compensation team will continue to provide our client community with weekly updates containing news and informed analysis on issues critical to their business.
The New York State Workers’ Compensation Board has extended the Formulary Deadline to January 1, 2021. The extension applies to prior authorization for renewal for non-formulary medications previously set at June 5, 2020 by the Phase 1 Business Information Project (BIS).
The New York State Workers’ Compensation Board issued an advisement that providers should use email, rather than fax for prior authorization requests. This follows the same advisement issued for the week ending April 3, 2020.
These instructions pertain to the following forms:
|Form Type||Carrier’s Email Address|
|Attending Doctor’s Request for Optional Prior Approval and Carrier’s/Employer’s Response (Form MG-1)||Contacts for Optional Prior Approval|
|Attending Doctor’s Request for Approval of Variance and Carrier’s Response (Form MG-2)||Contacts for Variance Approval|
|Attending Doctor’s Request for Authorization and Carrier’s Response (Form C-4 AUTH)||Contacts for Pre-Authorization|
The New York State Workers’ Compensation Board stated that Order of the Chairs (OOC) will only be issued for emailed requests that are not responded to in a timely manner. An OOC will not be issued for a faxed prior authorization request.
C-8.1b Disputed Medical Bill Guidance
File the C-8.1(b) form and cite the document number for the medical report in eCase, or indicate it is being sent on the same day if there is no ability to attach to the C-8.1b filing. Do not also mail the forms, or it will be considered a duplicate filing.
We recommend using the Genius Scan PDF Scanner app to scan medical bills for filing the C-8.1bs in a timely fashion.
Send the filings to firstname.lastname@example.org.
For a complete list of high-level guidance and updates from the New York State Workers’ Compensation Board, please see our New York State Workers’ Compensation Board COVID-19 Initiative Overview.
For more information or immediate guidance, contact: