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