Information Bulletin 04/01/09:  Facts about New York State Workers’ Compensation Board’s NEW C-4 Forms

Beginning April 1, 2009, the Board will only accept the new and revised C-4 family of forms.  The C-4.0, C-4.2, C-4.3 and C-4 AUTH were introduced on Sept. 16, 2008.

 

The CMS-1500 (HCFA-1500) forms will not be accepted by the Board after March 31, 2009.

 

The Board still accepts paper forms for the C-4, C-4.2 and the C-4.3. In fact, the C-4 AUTH form may only be filed on paper.

 

You may submit the C-4 and the C-4.2 electronically only if you submit through the NY WCB web portal.  These submissions cannot be retrieved for future C-4.2 filings. (SmartForms C-4.2 software allows retrieval of patient’s C-4.2 claims so providers can make updates and subsequent submissions, eliminating double entry of provider and patient information.)

 

Electronic Filing & the EC-4Narr

The Board has introduced an electronic-only form, the EC-4 NARR. This form replaces the C-4.0 and C-4.2.  The Doctor's Narrative Report (EC-4NARR) form will only be accepted through web submission of the Board's on-line EC-4Narr or through the XML batch submission process. The Board will accept the Doctor's Narrative Report (EC-4NARR) as an equivalent to the C-4 and C-4.2. 

DrsMagic complete practice management software includes the EC-4Narr and allows XML batch submissions.  DrsMagicä is a Board Authorized XML Submission Partner and has proven compliance with the Board's requirements for the electronic submission of the EC-4NARR and has executed the required legal agreement with the Workers' Compensation Board.

 

Repercussions for medical providers who do not submit the new C-4 forms

Medical providers who do not use the new C-4 forms, on or after, April 1, 2009 will be penalized. If the medical provider fails to submit the correct Board prescribed form, the liable self-insured employer, insurance carrier, third-party administrator, Re-opened Case Fund, or the State Insurance Fund is not required to pay the medical provider for any examinations, services and/or treatments included in the documentation submitted. In addition, the Board will investigate why the doctor is not using the correct new form and if warranted issue an administrative warning or commence temporary suspension or revocation proceedings.

The New C-4 Family of Forms: Frequently Asked Questions

Here are the common questions and answers heard at the recent NYS Workers Compensation Board EC-4Narr Online Filing Demonstration Seminars for Patient Health Care Providers.

1.                How do I start to file C-4 electronically?
Health Care Providers need to register to obtain a User ID & Password.

2.                Is it mandatory to file C-4 electronically?
No. You can mail the printed paper forms as you did before. By filing electronically, you save the cost of printing and mailing.

3.                Can I keep filing with the old C-4?
No. It is mandatory starting April 1st, 2009 to file with new C-4 forms, (10-08).

4.                If I file electronically, do I still need to mail the forms to the insurance carriers?
Yes, at least for now.

Note:  DrsMagic software allows electronic submission to the WCB and insurance carriers. 

5.                What is the difference between Web Submission and XML Submission?
Web Submission is to file one claim at a time; XML Submission is bulk/batch filing.

6.                We file lots of claims, it takes too much time to file one by one on the web, what should we do?
Contact a Board authorized XML submission partner and subscribe to their services to let you file in batches to the Board.  BayViewSoft’s DrsMagic is approved by NY WCB for XML submissions.

7.                What is the requirement for narrative text?
Click this link to find the NYS WCB detailed description of Narrative Requirements for the EC-4Narr form.

8.                Our office has several doctors, is it one registration or multiple?
Multiple. Each doctor needs to register.

9.                How long does it take to register?
About 1-2 weeks. You need to sign the registration form, mail it to the Board, and then they will mail you a User ID and password.

10.           Is there a way that we can link our existing software to the web site so that we are not doing double entry on all our patients?
No.

Note: Using DrsMagic software allows XML web submissions to the WCB and you will not have to enter patient information more than once. 

11. Can I file the Authorization Request (C-4Auth) electronically to the Board?
No. Only C-4, C-4.2 and EC-4Narr can be filed electronically to the Board.

12.We mailed C-4Auth to insurance, waited for long time without a response, what should we do?

By law, insurance carriers are required to respond within 30 days, but they can claim they did not receive your mail. A good solution is to work with DrsMagic to file electronically, and get an acknowledgement / confirmation from the insurance carrier.

13.How do I do XML Submissions?

Only Board authorized XML submission partners are approved to generate XML batch claims to submit to the Board.  DrsMagic is an authorized vendor.

14.After I filed C-4 on the web, can I retrieve the claims?
No, using the NYS web portal, once you complete a claim and submit, it is not retrievable.  If you use SmartForms C-4 Software program it will allow you to complete, file and retrieve claims.   Using DrsMagic practice management software will also allow you to retrieve claims already filed.

15.After I filed C-4 on the web, I found an error, what should I do? Is there a way I can void the previous filed claim?
No, but you can file a new one with the correct information. If you use DrsMagic it has built-in intelligence to check for errors.

16.Can the C-4 forms be faxed to the Board?
No. The C-4 forms must be mailed or filed electronically with the Board.

 

For more details click this link for the NY WCB C-4’s Frequently Asked Questions:

http://www.wcb.state.ny.us/content/main/hcpp/C4-FAQs.jsp

INFORMATION/ORDER: 1-866-681-1887 or Email: info@smartforms.com