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)