NYSDA Publications

WCB Issues Update on Online Health Care Claims Filing and Processing System

The New York State Workers' Compensation Board (WCB) has issued an update on its online filing and claims processing system for health care providers.

One-Year Anniversary of OnBoard: Limited Release

Moving PARs Online

OnBoard Icon CircleThis month marks the one-year anniversary of OnBoard: Limited Release (OBLR), the historic transfer of the Board’s paper submission and processing of prior authorization requests (PARs) to an online process where all PARs are submitted electronically.  OnBoard’s automated online processes have significantly expedited the delivery of medical care to New York’s injured workers.  The new system has improved the accuracy and efficiency of the request process by eliminating hundreds of thousands of paper forms, streamlining the addressing and delivery of requests, and providing automated status updates for providers and payers via the system dashboards.  As we celebrate one year of OnBoard: Limited Release, the Board would like to share some key data highlighting its success, as well as quick tips (based on lessons learned) to help stakeholders further maximize these efficiencies.

Key PAR data since launch

  • Chart Graphic825,000 PARs have successfully flowed through the system.
  • Nearly 95% of these PARs – 775,000 – have been processed without escalation to the Board’s Medical Director’s Office (MDO) for Level 3 reviews.
  • 100% of medication, behavioral health, and durable medical equipment PARs are fully resolved by the MDO within three days, with the vast majority resolved within one day.
  • MDO Level 3 reviews have been significantly expedited and are much faster than under the prior process.
  • In the 12 months since implementation, the Board has made over 20 system enhancements in direct response to user feedback.

10 tips to enhance your experience

  1. Idea LightbulbMake sure the correct PAR type is being submitted.
  2. Submit critical supporting documentation at the time of the original PAR submission and include a clear clinical rationale for the PAR in the medical narrative section.  (Please indicate why the clinical intervention is necessary.)
  3. Reference the specific MTG section in the PAR submission, and only use the “NONE” dropdown option when the MTGs do not address the treatment being requested.
  4. Check the OnBoard dashboard regularly to respond timely to requests for further information and to request Level 2 and Level 3 reviews in a timely manner.
  5. When escalating to a Level 3 MDO review, include a rebuttal that addresses the carrier’s Level 2 denial rationale in the “Escalation Reason” field, rather than simply copy/pasting the initially submitted rationale.
  6. Include the frequency, duration, and total number of requested clinical visits (if applicable) for the proposed treatment in the “Medical Necessity” text field.
  7. Confirmation PARs are purely optional for providers.  Submitting a Confirmation PAR for treatment you know is consistent with the MTGs could result in delay of your patient’s care.
  8. Payers should only use the Level 1 administrative denial “disallowed” when the condition or body part has been formally disallowed by the Board.
  9. Payers should respond to PARs in a timely manner to avoid receiving an Order of the Chair or a Notice of Resolution from the Medical Director’s Office.
  10. Failure by the carrier to respond timely to PARs will result in a waiver of the carrier’s right to challenge the PAR based on medical necessity.

Much more information regarding PARs is available on the Board’s website.  Please visit wcb.ny.gov/onboard, where you will find comprehensive training information for providers and payers alongside other OnBoard news and updates.  You can also sign up to receive OnBoard and other Board updates straight to your e-mail inbox with WCB Notifications.

Your continued feedback is important to us!

The Board has engaged in extensive outreach, both pre- and post-implementation of OnBoard, and has made a number of enhancements based on your feedback (with more underway!)  Within the next several weeks, the Board will be sending users a brief survey to obtain your additional insights and feedback – please watch for it and share your thoughts so we can make your OnBoard experience even better.

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