Patient Details Needed to Submit a Bill

PLEASE NOTE: The NYSIF Contact Center will not confirm for providers or third-party billers whether a claim is open, closed or retired, or what body parts are listed on a claim.
Providers can access EOB information through our medical provider portal.

To ensure expeditious medical bill processing, medical providers should submit their workers' compensation bills to the New York State Workers' Compensation Board 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 also must 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)

Workers' Compensation Board Forms for Health Care Providers

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