Notices and Updates
Notices and Updates
Provider Announcement: Mandatory Electronic Submission of CMS-1500 Forms for New York Workers’ Compensation Claims – Effective August 1, 2025
Effective August 1, 2025, the New York State Workers’ Compensation Board (NYS WCB) will require all healthcare providers to submit CMS‑1500 medical bills electronically for workers’ compensation claims. Paper submissions will no longer be accepted or processed by the Board.
What You Need to Know:
Who is Affected?
- All healthcare providers who treat injured workers in New York State
- Applies regardless of provider type, size, or volume
- Includes all services billed under the NY Workers’ Compensation system
What’s Changing?
- Paper CMS‑1500 forms will be rejected
- All claims must be submitted electronically through a Board-approved electronic submission partner (clearinghouse)
Compliance Deadline:
🗓 August 1, 2025 – No exceptions will be made after this date.
How to Comply:
How to Comply:
- Choose a Board-Approved Clearinghouse
Submit your CMS‑1500 forms electronically through an NYS WCB–authorized partner.
View the List of Approved Partners
- Update Your Billing Workflow
Coordinate with your billing team, EMR vendor, or third-party administrator to ensure your systems support electronic submission. - Verify Your Current Processes
Avoid denied claims by reviewing your existing NY workers’ compensation workflows and ensuring paper claims are discontinued before the effective date.
Important Note:
This mandate does not apply to Medicare, Medicaid, or private insurance claims, and is limited to New York workers’ compensation billing only.
Questions?
For assistance or to get started with an approved clearinghouse, please contact your billing vendor or the NY Workers’ Compensation Board directly at www.wcb.ny.gov.
PRIME HEALTH SERVICES IGS PROVIDER ANNOUNCEMENT 12/7/2022
With the recent announcement of our acquisition of the InterGroup provider network, we are pleased to welcome you to Prime Health Services, Inc., a national cost management solutions company.
Per the Assignment section of your existing contract, Intergroup has assigned your provider agreement to Prime Health Services, Inc.
With this transaction set to close on 12/31/22, clients will continue to access you for needed services, and payments to providers will continue as they do today. Any updates to your data can be submitted to updates@primehealthservices.com, and for DOS 1/1/2023 and after, any disputes related to pricing or application of the contractual rates can be submitted to disputes@primehealthservices.com.
As Prime Health merges the provider demographics and rate information into our system, we will also bring over any existing credentialing details and your current credentialing review cycle will remain active. Any inquiries specific to credentialing can be submitted to credentialing@primehealthservices.com.
For DOS after 1/1/2023, you will no longer see any indication of the Intergroup (IGS) network name on EORs. All bills processed will display PHS or Prime Health Services and any of our affiliates.
General questions not related to the topics mentioned above can be submitted to Provider Relations at providerrelations@primehealthservices.com.
Again, welcome to the Prime Health Services network and we look forward to a successful relationship.
No Surprises Act
Based on the disclosures required of group health plans and health insurance issuers in the No Surprises Act, Prime Health will provide the in-network providers’ negotiated rates.
Providing these deliverables allows transparency within tasks being asked of our clients and our clients’ clients.
At Prime Health, our provider contracts are evergreen and we can track when a provider (NPI) status is disabled or a contract (TIN) is termed. We also track dates on contracts and discounts when they are added/changed.
Prime Health uses commercially reasonable efforts to maintain accurate provider directories, which are regularly updated and verified at least every 90 days. Prime Health will respond, within one business day, to individuals who inquire about the network status of a provider or facility.
To aid in this initiative, with the use of technology, Prime Health is working with industry leaders in the provider data collection and verification space.
Attention New York Health Care Providers: CMS-1500 Updates
Beginning July 1, 2022, health care providers will need to:
• Submit the CMS-1500 form. Electronic submission through an XML submission partner is strongly encouraged, though not required. When mandatory submission of the CMS-1500 form begins, use of current medical billing/reports including Doctor’s Initial Report (Form C-4) and Doctor’s Progress Report (Form C-4.2) will be discontinued.
• Prominently report the injured worker’s temporary impairment percentage, work status and the causal relationship of the injury at the top of the CMS-1500 form medical narrative.
Between now and July 1, 2022 health care providers are urged to review their processes to understand how these changes will affect them. The Board will continue to post periodic updates to the website based on feedback and questions received from stakeholders.
More information can be found at http://www.wcb.ny.gov/CMS-1500/