To submit the CMS-1500 Medical Narrative Report, send the completed form to the Workers' Compensation Board along with all necessary attachments. Depending on your procedure, you may submit via fax to 1-800-123-4567 or email to submit@wcb.ny.gov. For physical submissions, mail to WCB Disputed Bill Unit, PO Box 5205, Binghamton, NY 13902-5205. Ensure to check for deadlines and follow-up if confirmation of receipt is not received within the stated timeframe. Proper submission enhances the efficiency of your claim processing.

Important dates regarding the CMS-1500 form submission include report submissions within 48 hours for initial reports and within 15 days for progress reports. Ensure all necessary deadlines are met to facilitate timely processing of claims. Familiarize yourself with any specific dates related to your case or client's situation.

The CMS-1500 Medical Narrative Report serves to document a patient's medical history and treatment relating to a workers' compensation claim. It helps healthcare providers communicate vital information regarding the causal relationship and impairment status. This form is crucial for ensuring claims are processed accurately and efficiently.

• 1. Patient's Name: Full name of the patient for identification.
• 2. Patient's Date of Birth: The birth date of the patient.
• 3. WCB Case Number: If known, the specific case number assigned by the Workers' Compensation Board.
• 4. Insurer Case Number: The case number assigned by the insurance provider.
• 5. Date of Injury / Onset of Illness: Date when the injury occurred or illness began.
• 6. Provider's Name: Name of the healthcare provider filling the report.
• 7. Provider's NPI Number: National Provider Identifier number for the healthcare provider.
• 8. WCB Authorization Number: The authorization number from the Workers' Compensation Board.
• 9. WCB Rating Code: Code that specifies the rating for the case.
• 10. Date(s) of Service: Dates when the medical services were provided.
• 11. Work Status: Details on whether the patient missed work due to the injury.
• 12. Causal Relationship: Indicates if there is a link between the patient's complaints and the injury.
• 13. Temporary Impairment Percentage: Percentage of temporary impairment resulting from the injury.
• 14. Narrative with Examination Findings: Provider's detailed findings from the medical examination.
• 15. Provider's Signature: Signature field for the healthcare provider.
• 16. Date: Date of the report's completion.

Failure to submit the CMS-1500 form can lead to delays in the processing of workers' compensation claims. It may result in claims being denied or requiring additional follow-up documentation. Ensuring timely submission is crucial to avoid complications in claims processing.

• Claim Delays: Submissions made after deadlines can slow down claims resolution.
• Claim Denials: Incomplete or late submissions might lead to automatic denial of claims.
• Legal Repercussions: Failing to submit required forms may affect compliance with legal stipulations.

• 1. Initial Injury Report: Used to report the patient's initial treatment following a work-related injury.
• 2. Progress Reporting: To detail ongoing treatment and evaluate recovery status.
• 3. Claim Documentation: Essential for creating a formal record for claims assessment.