In order to increase health care provider participation in the workers' compensation system and improve injured workers' access to timely, quality medical care, the Workers' Compensation Board (Board) made a strategic decision to transition toward making the CMS-1500 a required form.

Providers have indicated that the unique paperwork requirements currently in the workers' compensation system are time consuming to complete. To reduce the administrative burden and increase provider participation, the Board will consolidate and eliminate certain medical billing forms and convert to the CMS-1500, the universal claim form used by medical providers to bill the Centers for Medicare and Medicaid Services (CMS) as well as health insurers.

The initiative will leverage providers' current medical billing software and medical records while promoting a more efficient workers' compensation system.

The Board replaced the following forms with the CMS-1500:

• Doctor's Initial Report (Forms C-4, EC-4)
• Continuation to Carrier/Employer Billing Section (Form C-4.1)
• Doctor's Progress Report (Forms C-4.2, EC-4.2)
• Ancillary Medical Report (Forms C-4AMR, EC-4AMR)
• Doctor's Narrative Report (Form EC-4NARR)
• Occupational/ Physical Therapist's Report (Forms OT/PT-4, EOT/PT-4)
• Psychologist's Report (Form PS-4)
• Ophthalmologist's Report (Form C-5)

The CMS-1500 must be submitted with a detailed narrative report to be considered a valid submission The Board has developed a template that providers can use to create the medical narrative report that accompanies provider submissions of the CMS-1500. A sample of the template can be found on the CMS-1500 Requirements page.

Benefits of electronic submission

• Faster bill payments.
• Reduced administrative burden - the electronic submission partner submits the CMS-1500 to the insurer and the Board.
• Increased certainty, including electronic acknowledgement of the insurer's receipt (removing unnecessary duplicate submissions), and confirmation of acceptance/rejection of the bill within seven days.
• Faster identification and correction of technical errors, and quicker resubmission (no waiting until insurer denies the bill).
• No cost or low cost.

CMS-1500 Submission Process

• Effective August 1, 2025, providers are required to partner with a clearinghouse (electronic submission partner) who will ensure that the medical bill and narrative attachment are sent and accepted by the correct payer.
• When partnered with an electronic submission partner, providers do not need to complete a CMS-1500 form but rather submit their bill and narrative attachment to the electronic submission partner they have the relationship with in an agreed-upon format. The agreed-upon format can be paper.
• The electronic submission partner will forward the bill and narrative attachment to the workers' compensation payer.
• The payer will accept the CMS-1500 from the electronic submission partner and return electronic acknowledgement of receipt.
• The electronic submission partner will forward the acknowledgement, including receipt date, to the provider.
• Electronic submission partners will transmit, in the designated XML format, the billing data (including the payer's acknowledgement of receipt), and the image of the CMS-1500 forms and narrative attachments to the Board. The CMS-1500 forms and narrative attachments received by the Board will be combined and displayed in the applicable injured workers' WCB case folders.

When CMS-1500 forms are submitted to the Board using the electronic submission process, providers SHOULD NOT mail, fax or email a duplicate paper form to the Board.

Questions can be directed to: CMS1500@wcb.ny.gov

View a video presentation for providers on CMS-1500 and the Expanded Provider Law.

View a recorded version / Slides of our CMS-1500 Provider Q&A webinar.