Attention, New York medical providers: The Workers’ Compensation Board changed how it handles some requests for durable medical equipment for injured workers.

Catherine Montgomery

According to a recent WCB bulletin, the change applies to cases where:

• The provider submits a prior authorization request for a DME item.
• The Official New York Workers’ Compensation DME Fee Schedule does not list a price for the DME item.
• The WCB issues an order of the chair to resolve the PAR.

In such cases, the OOC will note the provider’s cost estimate for the DME item in question. Additionally, on March 27, the WCB deleted all draft PARs and draft payer responses to PARs in the OnBoard system, through which providers submit all PARs.

Providers may have to re-initiate all draft PARs they did not submit before 6 p.m. Eastern on March 27.

N.Y. workers’ comp PARs

In New York workers’ comp, providers generally do not have to submit a PAR when the state’s Medical Treatment Guidelines recommend the treatment in question.

Though providers have the option of submitting PARs to confirm MTG compliance, PARs are a requirement only for:

• Treatments that the MTGs do not list.
• Variances from the MTG.
• Non-formulary medications.
• “Special Services” as defined in the MTGs.
• DME that is not in the Official DME Fee Schedule or that the DME Fee Schedule specifically lists as requiring a PAR.

The DME Fee Schedule indicates whether the provider must submit a PAR for each DME item and the “NYS WC Fee” for the item where applicable.

New enhancement: DME not in fee schedule

The DME Fee Schedule does not list a “NYS WC Fee” for some DME items. According to an OnBoard News release, in cases where the provider submits a PAR for DME, and the DME Fee Schedule does not list the price, “[T]he estimated cost provided by the provider for the DME item in a PAR will be noted on all subsequently issued orders of the chair.”

According to the board's PAR Process page, when a provider uses the OnBoard system to submit a PAR, OnBoard automatically tracks the deadline for a claims administrator to respond to the PAR. For DME, the deadline to respond to a PAR is four calendar days.

If the claims administrator fails to respond to a PAR timely, the WCB may issue an OOC.

WCB deleted draft PARs for March 27, 2025

According to the OnBoard News release, the WCB deleted all draft PARs from providers and provider delegates (along with all draft PAR responses from payer reviewers) in the OnBoard system at 6 p.m. on March 27.

Providers may wish to confirm if there were any draft PARs in the system that they or their delegates did not submit before the mass deletion. If so, be sure to re-initiate the process of submitting these PARs.

Catherine Montgomery is the co-founder and CEO of daisyBill, a provider of workers' comp end-to-end revenue cycle management software. This post appears with permission.