As discussed during the past year, the NYSCA Insurance Committee (The NIC) anticipated significant changes in insurance offerings and benefits, especially within the 2026 Medicare Advantage market. Some carriers no longer offer a Medicare Advantage benefit, discontinued their programs in numerous counties throughout the country or changed their offerings.
The NYSCA Insurance Committee (The NIC) continues to communicate and work with the NYS Workers' Compensation Board (WCB) to keep our members updated on current and forthcoming changes that may impact your care of New York's injured workers. Since our December 23rd notice on the Third-Party Administrator (TPA) changes, we have received a letter directed to our members from the President of FCS Administrators.
The NYSCA Insurance Committee (The NIC) has been communicating with both the Workers' Compensation Board and Third-Party Administrators to define and advise our members on a recent change impacting the Special Fund for Disability Benefits, the Uninsured Employers’ Fund, the Second Injury Fund (also referred to as the Special Disability Fund), and the Fund for Reopened Case. This change has already been implemented - seemingly without overt provider communication on many of these cases.
On October 1, 2025, the Workers’ Compensation Board (Board) announced updates to the Notice of Objection to a Payment of a Bill for Treatment Provided (Form C-8.1B) requiring payers to provide a detailed explanation of their objections to bills for medical treatment in boxes 12 and 20 within Section C, Objection Reasons-Legal and Medical Treatment Guidelines.
It has come to the attention of the NYSCA that some plan materials for certain 2026 Medicare Advantage (Part C) plans have included language that may appear confusing and contradictory. We want to assure members that chiropractic spinal manipulation to correct a subluxation (active treatment) remains a covered service under all Medicare Advantage plans, consistent with Medicare Part B coverage.
ICD-10 applies to all parties covered by the Health Insurance Portability and Accountability Act (HIPAA), not just providers who bill Medicare or Medicaid. ICD10 diagnosis codes an updated every year. Improper coding will result in a claim denial. Remember, proper coding is essential for documentation, reporting and reimbursement.
Recently, the NYS Workers' Compensation Board released an updated version of the C-4.3 permanent impairment form. For more information please login to the NYSCA website:
The Workers’ Compensation Board (Board) is requiring health care providers to submit the CMS-1500 universal billing form electronically, through a Board-approved electronic submission partner, effective August 1, 2025. Starting that date, the workers’ compensation payer can deny payment of services if the CMS-1500 form was not submitted through a Board-approved electronic submission partner and the Board will not enforce payment.
Don't miss this important deadline and instructions to file for your portion of the multi billion dollar BCBS litigation settlement.
Have you received a UHC Medicare Advantage claim denial indicating 'precertification/ authorization/ notification absent' for cases where clinical submission was not required? Did you follow the correct process? If so, we need redacted examples of cases indicating this disconnect so that Optum and UHC can address this issue.
National Government Services (NGS) wants to share with our providers an urgent issue that has been identified by the Centers for Medicare & Medicaid Services (CMS).
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.
For additional information, please access this NYSCA Member's Only link:
For well over a year, the NYSCA Insurance Committee (the NIC) has reported on an antitrust class action lawsuit due to the overlap of Blue Cross Blue Shield (BCBS) plans. The settlement has been approved, including $2.8 Billion in a settlement fund. It is important to note the settlement also includes new requirements on how BCBS processes claims, communicates, and makes payments to healthcare providers. This involves all BCBS plans nationwide. Any health care services rendered over the past 15+ years are eligible to be part of this settlement.
For more information, including how to file a claim and an upcoming webinar on Friday, May 2, 2025, please click the link below:
Beginning 5/19/2025, there is a new mailing address for Medicare Part B claim submitters in Connecticut and New York (Upstate Counties and Queens).
On Monday, March 24th, the NYS Workers' Compensation Board posted notice regarding changes to durable medical equipment (DME) prior authorization requests (PARs), which also impacts all draft PARs (whether from providers, their delegates, or responses from payer reviewers).
Last week Excellus BlueCross BlueShield and Univera Healthcare sent letters to their Medicare Advantage members receiving chiropractic care. The NYSCA Insurance Committee (NIC) has spoken with numerous NYSCA doctors regarding this notice and the impact on their practices.
Thank you to those who attended our recent CMS-1500 webinar for health care providers, highlighting that, beginning August 1, 2025, the Board will require health care providers to contract with an electronic submission partner to submit the CMS-1500 universal medical billing form electronically on their behalf.
If you participate with UnitedHealthcare / Optum you may have received notice of the change in the aforementioned prior authorization program. Based upon the volume of calls, texts, and emails received by the NYSCA Insurance Committee (NIC), there has been several interpretations of the information published by UHC. For more information please access the following link:
