In order to increase health care provider participation in the workers' compensation system and improve injured workers' access to timely, quality medical care, the Workers' Compensation Board (Board) made a strategic decision to transition toward making the CMS-1500 a required form.
Providers have indicated that the unique paperwork requirements currently in the workers' compensation system are time consuming to complete. To reduce the administrative burden and increase provider participation, the Board will consolidate and eliminate certain medical billing forms and convert to the CMS-1500, the universal claim form used by medical providers to bill the Centers for Medicare and Medicaid Services (CMS) as well as health insurers.
The initiative will leverage providers' current medical billing software and medical records while promoting a more efficient workers' compensation system.
The Board replaced the following forms with the CMS-1500:
- Doctor's Initial Report (Forms C-4, EC-4)
- Continuation to Carrier/Employer Billing Section (Form C-4.1)
- Doctor's Progress Report (Forms C-4.2, EC-4.2)
- Ancillary Medical Report (Forms C-4AMR, EC-4AMR)
- Doctor's Narrative Report (Form EC-4NARR)
- Occupational/ Physical Therapist's Report (Forms OT/PT-4, EOT/PT-4)
- Psychologist's Report (Form PS-4)
- Ophthalmologist's Report (Form C-5)
The CMS-1500 must be submitted with a detailed narrative report to be considered a valid submission The Board has developed a template that providers can use to create the medical narrative report that accompanies provider submissions of the CMS-1500. A sample of the template can be found on the CMS-1500 Requirements page.
