New York Workers' Comp Electronic Billing

CMS-1500 & Electronic Medical Narrative Submissions

MANDATE: Electronic CMS-1500 filing is required.
SOLUTION: Universal CMS-1500 & electronic submission partner integration.

Current Electronic Billing Mandates

  • Transitioning from C-4 Forms to the CMS-1500 Mandate: Effective July 1, 2022, the New York State Workers' Compensation Board (NYS WCB) mandated (opens in new tab) the use of the CMS-1500 universal billing form. This mandate officially replaced and discontinued 12 legacy custom forms, including the C-4, C-4.2, C-4AMR, EC-4NARR, and OT/PT-4. All CMS-1500 submissions must now be accompanied by a detailed medical narrative report to be considered a valid submission, as detailed in the NYS WCB Bulletin on Discontinued Forms (opens in new tab).
  • The August 2025 NYS WCB Electronic Filing Mandate: Electronic filing is no longer just a faster alternative to paper; it is a legal requirement to ensure payment in New York. As of August 1, 2025, the NYS WCB strictly requires all healthcare providers to submit their CMS-1500 forms electronically (opens in new tab) via a Board-approved electronic submission partner. The WCB will no longer act upon or enforce payment of paper CMS-1500 forms, giving payers the right to deny them outright. To help practices transition, providers are permitted to use CPT code 99080 to bill payers up to $1 per electronic bill (opens in new tab) to offset the electronic submission costs.
  • Modern National Electronic Attachment Standards: The healthcare industry is actively eliminating manual faxes and paper documentation through aggressive federal action. The recent CMS-0053-F final rule (opens in new tab) establishes the first-ever HIPAA-adopted national standards for the electronic exchange of health care claims attachments, such as clinical notes, X-rays, and diagnostic results. Full compliance with these electronic standards is legally required by May 26, 2028, and the transition is projected to save the healthcare industry roughly $781 million annually by eliminating manual processing overhead.