Information Needed to Submit a Workers' Compensation Bill

Medical providers can ensure expeditious medical bill processing by submitting their bills with the following demographic information about the injured worker:

      • First and last name
      • Home address
      • Phone number(s) (if known)
      • Social Security Number
      • Date of birth
      • Date of accident
      • Employer’s name
      • Employer’s policy number (if known)
      • NYSIF case number (if known)
      • Workers Compensation Board (WCB) case number (if known)

Medical bills must be accompanied by appropriate, legally required, medical reports. Providers must submit the following information about the worker's injury/illness:

  • Description of accident or occupational disease
  • Detailed description of injury
  • Opinion as to whether the incident as described was cause of injury/illness
  • Details of prior injuries, diseases or physical impairment, including prescription drug history
  • Date of first treatment
  • Current diagnosis, prognosis and anticipated treatment plan, including if treatment is continuing, and next scheduled treatment date
  • ICD 10 (International Classification of Diseases, 10th Revision) code for each diagnosis
  • Results of diagnostic tests rendered
  • Medical necessity for any treatment, diagnostic test(s) or surgery
  • First day (“date”) injured worker was unable to perform work due to his/her impairment
  • Injured worker's current work status
  • Ability of patient to perform regular duties; if no, why
  • Ability of patient to perform any type of work; if yes, describe work capacity
  • Work restrictions, as well as the degree of disability: total, marked, moderate or mild

Medical providers must also include the following information about the treating physician:

  • Tax ID number
  • Billing address
  • WCB rating code
  • WCB authorization number
  • Name of treating provider and treatment location address
  • Each date of service
  • The billing code such as the CPT code, HCPCS code (Durable Medical Equipment), NDC number (Prescription Drugs)

New York State Workers' Compensation Board Forms for Health Care Providers