Treatment Authorizations & Variances Requests

The New York State Workers’ Compensation Board recently implemented a Prescription Drug Formulary, which lists the medications eligible for reimbursement under a claimant’s workers' compensation medical coverage. Beginning December 5, 2019, all new prescriptions for injured workers must comply with the requirements of the Formulary. Beginning June 5, 2020, all refills and renewals must comply with the Formulary.

Over the next several months, claimants should discuss each of their medications with their health care providers to determine if their medication is reimbursable under their workers’ compensation medical coverage and make appropriate changes as necessary. Health care providers have been notified of the new drug formulary and should be anticipating the discussions with their patients. For more information, visit the WCB Formulary website.

Medical providers should submit their Attending Doctor's Request for Authorization (C-4Auth) requests and Medical Treatment Guideline (MTG) Variance Requests, forms MG-2 and MG-2.1, to the MTG teams in their respective NYSIF business offices. Please note your respective NYSIF business office e-mail, fax and claim unit numbers provided below:

NYSIF Medical Treatment Authorization and Variance Request Teams
Office MTG Shared E-mail Box MTG Shared Fax Claim Units
Syracuse/CLIO NYSIF-MG2-C4Auth@nysif.com (212) 587-7540
40, 60, 61, 62, 63, 64, 65, 66, 67, 68, 138, 214, 224, 400, 403, 404, 410, 412, 415, 520, 522
NYC Claims Division 1 NYSIF-MG2-C4Auth@nysif.com (212) 587-7540
302, 304, 306, 308, 323, 324, 328, 329, 362, 363, 364, 365, 370, 371, 372, 373
NYC Claims Division 2 NYSIF-MG2-C4Auth@nysif.com (212) 587-7540
20, 50, 52, 53, 54, 57, 58, 59, 152, 204, 311, 327, 331, 361, 366, 381
York Claims Processing MG2@wellcomp.com (614)-717-6152  271
Corvel ClaimsProcessing GM-SYNY-Claims@corvel.com (212) 587-9295  272
NASSAU mtg-nassau@nysif.com (631) 756-4206 100, 102, 104, 105, 106, 107, 108, 109, 110, 111, 113, 114, 116, 117, 118, 119, 121, 122, 123, 124, 125, 126, 127, 129, 141, 142, 199, 213
SUFFOLK mtg-suffolk@nysif.com (631) 756-4272 55, 217, 235, 236, 237, 238, 239, 240, 241, 242, 243, 244, 245, 246, 247, 248, 249, 250, 251, 252, 253, 254, 255, 256, 257, 260, 261, 262, 263
WHITE PLAINS mtg-whiteplains@nysif.com
(914) 701-2188 145, 152 153, 154, 155, 156, 157, 162, 163, 164, 165, 166, 167, 168, 169, 170, 171, 172, 173, 174, 175, 176, 177, 179, 190, 191, 211, 215, 221, 225
ALBANY mtg-albany@nysif.com (518) 437-8997 25, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 180, 181, 182, 183, 184, 185, 212, 997 
BUFFALO mtg-buffalo@nysif.com (716) 851-2096 80, 81, 82, 83, 84, 85, 86, 89, 140, 146, 202, 209, 218
ROCHESTER mtg-rochester@nysif.com (585) 258-2004 70, 71, 72, 74, 75, 77, 78, 79, 205, 216
SYRACUSE mtg-syracuse@nysif.com
(315) 453-8337 61, 62, 63, 64, 65, 66, 67, 68, 138, 520, 522
BINGHAMTON mtg-binghamton@nysif.com
(607) 741-5605 281, 282, 283, 284, 285, 286, 287, 288, 289

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