Key Takeaways

  • As part of the CMS-1500 requirements, the New York Workers’ Compensation Board issued updates to the C-8.1 and C-8.4 forms to clarify potential legal and valuation objections

  • The new forms will become effective on July 1, 2021

  • The new form C-8.1 adds an objection to allow insurers to object to a medical bill if it is not sent in an electronic format, which is effective for bills submitted on or after August 16, 2021

On occasion, the New York Workers’ Compensation Board issues general policy statements to provide updates on procedure and legal updates. As part of the CMS-1500 requirements, the Board recently addressed the soon-to-be-effective updates to the C-8.1 and C-8.4 forms―pending their elimination when OnBoard goes live.

The update to form C-8.1 eliminates certain sections currently found on the left side of Form C-8.1, specifically Part A, which provides a notice of objection regarding further or future treatment. With the elimination of Part A, one of the objection reasons currently on Part A of Form C-8.1 is: “requested treatment is not for an established site or condition.” This will be transferred to the RFA-2 form that will be published later in 2021.

The new form C-8.1 allows insurers to object to a medical bill if it is not sent in an electronic format, which is effective for bills submitted on or after August 16, 2021. Insurers will also have the option to share these objections with providers by providing access to a secure online system. However, if insurers choose to do so, they must notify the provider by email each time and it must include the information included in the subject number.

The new forms will become effective on July 1, 2021. As of July 1, it will also be required to use Claim Adjustment Reason Codes and Remittance Advice Remark Codes as an explanation of benefits sent to a health care provider to object to medical bill payments. The new C-8.1 and C-8.4 forms will include these codes.