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Notices and Updates

Notices and Updates

Based on the disclosures required of group health plans and health insurance issuers in the No Surprises Act, Prime Health will provide the in-network providers’ negotiated rates.

Providing these deliverables allows transparency within tasks being asked of our clients and our clients’ clients.

At Prime Health, our provider contracts are evergreen and we can track when a provider (NPI) status is disabled or a contract (TIN) is termed. We also track dates on contracts and discounts when they are added/changed.

Prime Health uses commercially reasonable efforts to maintain accurate provider directories, which are regularly updated and verified at least every 90 days. Prime Health will respond, within one business day, to individuals who inquire about the network status of a provider or facility.

To aid in this initiative, with the use of technology, Prime Health is working with industry leaders in the provider data collection and verification space.

Beginning July 1, 2022, health care providers will need to:

• Submit the CMS-1500 form. Electronic submission through an XML submission partner is strongly encouraged, though not required. When mandatory submission of the CMS-1500 form begins, use of current medical billing/reports including Doctor’s Initial Report (Form C-4) and Doctor’s Progress Report (Form C-4.2) will be discontinued.

• Prominently report the injured worker’s temporary impairment percentage, work status and the causal relationship of the injury at the top of the CMS-1500 form medical narrative.

Between now and July 1, 2022 health care providers are urged to review their processes to understand how these changes will affect them. The Board will continue to post periodic updates to the website based on feedback and questions received from stakeholders.

More information can be found at http://www.wcb.ny.gov/CMS-1500/