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 email, fax and claim unit numbers provided below:

NYSIF Medical Treatment Authorization and Variance Request Teams

Office MTG Shared Email Box MTG Fax Claim Units
ALBANY NYSIF-MG2-C4Auth@nysif.com (212) 587-7540 25, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 180, 181, 182, 183, 184, 185, 212 
BINGHAMTON NYSIF-MG2-C4Auth@nysif.com (212) 587-7540 281, 282, 283, 284, 285, 286, 287, 288, 289
BUFFALO NYSIF-MG2-C4Auth@nysif.com (212) 587-7540 80, 81, 82, 83, 84, 85, 86, 89, 140, 146, 202, 209, 218
NASSAU NYSIF-MG2-C4Auth@nysif.com (212) 587-7540 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
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
ROCHESTER NYSIF-MG2-C4Auth@nysif.com (212) 587-7540 70, 71, 72, 74, 75, 77, 78, 79, 205, 216
SUFFOLK NYSIF-MG2-C4Auth@nysif.com (212) 587-7540 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
SYRACUSE/CLIO (Central Loss Intake Office) NYSIF-MG2-C4Auth@nysif.com (212) 587-7540
60, 61, 62, 63, 64, 65, 66, 67, 68, 138, 214, 224, 400, 403, 404, 410, 412, 415, 520, 522
WHITE PLAINS
NYSIF-MG2-C4Auth@nysif.com
(212) 587-7540 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
York Claims Processing MG2@wellcomp.com (614)-717-6152  271
CorVel Claims Processing GM-SYNY-Claims@corvel.com (866) 727-5573   272

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