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Substance Over Form? A Guide to the New York State Workers’ Compensation Board’s CMS-1500 Initiative and C-4AUTH Denials

July 25, 2018

In April, the New York Workers’ Compensation Board announced its goal to implement measures to improve access to health care by increasing provider participation in the system. The board will attempt to increase participation with increased fees, simplified forms, and “other enhancements” including providing a medical portal and expanding patient access to different types of medical providers.
The first significant change is the elimination of the requirement to file a C-8.1A when completing a C-4AUTH denial. The board has also chosen to adopt the ubiquitous CMS-1500 (previously the HCFA-1500) in order to reduce the burden of paperwork on providers. We examine the C-4AUTH denial decision and take a deep dive into the CMS-1500, examining its timeline for implementation, key changes for providers and insurers, and more.

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