Information Needed for Medical Bill Submission

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

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

Information submitted by medical providers should include:

• 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) 

Medical bills must be accompanied by appropriate, legally required, medical reports. Such medical reports need to include Required Medical Bill Info

WCB forms available to Medical providers:

C-4 “Attending Doctor's Report” 

C-4.1 “Continuation to Carrier/Employer Billing Section C-4, C-5, PS-4 or OT/PT-4” 

C-5 “Attending Ophthalmologist's Report” 

C-64 “Proof of Death by Physician Last in Attendance on Deceased”  

C-72.1 “Record of Percentage Hearing Loss”

FCE–4 “Practitioner’s Report of Functional Capacity Evaluation”

OT/PT–4 “Occupational Therapist’s or Physical Therapist’s Report