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 by six months from June 5, 2020 to to January 1, 2021
The Board re-upped on its advisement that providers should use email, rather than fax for prior authorization requests
We offer guidance regarding scanning and filing C-8.1b Disputed Medical Bill forms
New York State Workers’ Compensation Board Extends Formulary Deadline to January 1, 2021
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).
- Health care providers and injured workers
- Provides a six-month extension for portal requests and management of prior authorization and variance requests online (e., MG-1, MG-2 and C-4 AUTH)
- Mitigates the impact of implementation requirements to ensure that there is no negative effect to injured workers for prescription renewals consistent with the Formulary
Insurance Carriers, Self-Insured Employers, and TPAs Directed to Designate Email Contacts
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:
|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
- All health care providers are directed to use the designated email address as the preferred means of contact for MG-1, MG-2, C-4 AUTH requests.
- Insurance carriers, self-insured employers, and TPAs were again advised to forward any current designated email updating the Medical Treatment Guidelines administrators.
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.
- Subject 046-1048
- 12 NYCRR 325-1.4
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 email@example.com.
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:
- Christina M. Hassler
- Damon M. Gruber
- Sean J. McKinley
- Or another member of our Workers’ Compensation practice