Action Required: NYS Mandates Electronic CMS-1500 Billing by August 1
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Effective August 1, 2025, the NYS Workers’ Compensation Board (Board) will require health care providers to submit the CMS-1500 universal billing form electronically, through a Board-approved electronic submission partner. But don’t wait! All providers are encouraged to move to electronic submission as soon as possible to take advantage of key benefits. The Workers’ Compensation Board (Board) is pleased to continue its CMS-1500 webinar series for providers
Benefits to health care providers
Submitting the CMS-1500 through an electronic submission partner benefits providers in several ways, including more timely payment and reduced administrative burden. Providers will get date/time stamp acknowledgement of receipt from the insurer, so they’ll know they do not need to resubmit the bill. Additionally, any technical errors will be identified quickly so they can be corrected and resubmitted — instead of waiting weeks, only to have the insurer deny a bill due to a minor technical error.
Submission partners
There are currently eight Board-approved electronic submission partners. You can find a list of electronic submission partners with their contact details at wcb.ny.gov/submissionpartners. As indicated on the website, some of these partners will continue to accept paper CMS-1500 forms from providers who wish to continue using them. In these instances, the partner will convert the forms and submit them electronically to the payer and the Board. Note that the Board does not endorse any particular electronic submission partner; providers should choose the partner that best fits their needs. If you are not currently working with an electronic submission partner, this fact sheet will guide you through the process step-by-step.
Offsetting the expense of using an electronic submission partner
Electronic submission comes at low or no cost. Health care providers can offset most, if not all, of the cost using CPT code 99080 on the CMS-1500. This code is available now to all providers submitting bills electronically. Note that the price providers enter when using code 99080 should accurately reflect the actual cost of the electronic transmission of the individual bill (based on the agreement with their chosen electronic submission partner), up to a maximum of one dollar.
Don’t wait!
While the Board’s mandate does not take effect until August 1, 2025, providers who begin the transition earlier will experience the benefits of using electronic submission that much sooner. We encourage providers to get started now by reviewing the list of electronic submission partners on the Board’s website (wcb.ny.gov/submissionpartners) and finding one that works for them.
Visit the CMS-1500 section of the Board’s website for complete details and email [email protected] with any questions.
