NEW YORK WORKERS’ COMP – MEDICAL CARE
Getting your medical care approved, paid, and recorded.
How treatment authorization, the Medical Treatment Guidelines, billing, and your medical records work once a claim is open.
OnBoard
where treatment requests are submitted
MTG
guidelines that pre-approve most care
CMS-1500
the form your provider bills and reports on
Mileage
travel to treatment can be reimbursed
How your medical benefits work
Getting treatment approved
Care that fits the Medical Treatment Guidelines is generally pre-authorized; for treatment outside them, the provider files a request – often a variance – through the OnBoard portal.
What the guidelines cover
The MTGs set the expected treatment, limits, and maintenance care for common body parts and conditions, which is why most in-guideline care needs no separate sign-off.
Bills, prescriptions, and reimbursement
You should not pay out of pocket for authorized care; prescriptions, durable equipment, and travel to appointments each have their own rules and reimbursement paths.
Your medical documentation
Providers bill and report on the CMS-1500 with a narrative; the C-4.3 permanent-impairment report remains a current form and is submitted alongside it.
Stuck getting care approved or paid?
Tell us which treatment or bill is in question and we will help you understand how the process should work.