Circular Letter No. 35 (2000)
December 11, 2000
TO: |
All Licensed Property/Casualty Insurers Authorized To Write Workers' Compensation Insurance In New York State |
RE: |
Workers' Compensation Board's Treatment Utilization Pilot Program |
The New York State Workers' Compensation Board (WCB) is conducting a Treatment Utilization Pilot Program focused on Authorized Orthopedic Specialists in the Buffalo, New York area. The purpose of this program is to determine whether higher reimbursement rates have an effect on reducing utilization. The WCB will establish an evaluative methodology to review and evaluate the experience of the treating physicians during the pilot project.
As part of the pilot program, the WCB is authorizing, for accidents occurring on or after December 1, 2000, that participating providers be reimbursed in accordance with the Region 4 (New York City area) rates. These reimbursement rates will be in effect for a period of three years, or as long as the participants continue to participate in this pilot program and meet the data reporting requirements as defined by the WCB. A list of participating providers and the fee schedule will be sent under separate cover by the WCB.
Please note that the pilot program's fee schedule should not be used for reimbursement to participating providers under any other program, such as New York's No-Fault law.
The WCB has also established a control group of 100 randomly selected orthopedic specialists in Region 2. Insurers will be required to submit an electronic data set for this control group to the WCB on a semi-annual basis. The WCB will notify you of the specific dates that these reports should be submitted. Providers making up that control group are listed in Attachment 1 of this letter. The format for the electronic reporting of this control group is described in Attachment 2. The receipt of this data by the WCB is essential and will form the comparative basis for the study.
The (WCB) has established the data reporting requirements contained in Attachment 2. In addition to the instructions contained therein, please note the following:
- All data must be provided in an ASCII delimited (tab or comma) file.
- Large files should be compressed or zipped.
- All files must have the appropriate header columns to differentiate the data elements.
Please complete the contact information form (Attachment 3 to this letter) and return the information, within 10 days of the receipt of this Circular Letter, to:
New York State Workers' Compensation Board
Bureau of Health Management - Att.: Lynne Cuva, Room 200-B
20 Park St.
Albany, NY 12207
If you have any questions regarding the pilot program or the reporting requirements, please contact Lynne Cuva (518-486-3330) or Mark Arunasalam (518-402-6361) at the WCB.
Very truly yours,
Mark Presser
Assistant Deputy Superintendent
and Bureau Chief
Property Bureau
Attachment 1
Control Group Orthopedic Specialists
Data to be submitted on a semi-annual basis
WCB# | Provider Name |
---|---|
100795-4 | Al-Khalidi Farouq |
070782-8 | Altchek Martin |
039206-8 | Bastable Stephen |
103551-8 | Benton Louis J Jr |
122662-0 | Bernstein Michael L |
199426-8 | Bessette Gary Charles |
153339-7 | Bhanusali Govindlal K |
107052-3 | Buerkle August R Jr |
090643-8 | Burton Richard Irving |
112578-0 | Cady Robert Brown |
143337-4 | Cambareri John Joseph |
194781-1 | Cannizzaro John Patrick |
187689-5 | Capecci Robert |
143645-0 | Carl Allen Laurence |
092763-2 | Carpenter Charles Worden |
187687-9 | Carrier David Alan |
089524-3 | Carrier Robert Hodge |
208747-6 | Chambers Robert Edward |
156784-1 | Ciszewski William Andrew |
087506-2 | Cole Harry Maurice |
164065-5 | Connolly Patrick J Jr |
187784-4 | Daino Terrance Michael |
196389-1 | Damron Timothy Arthur |
150394-5 | Decamp Christopher D |
122689-3 | Dehaven Kenneth E |
192639-3 | Delsavio Gina Carmela |
156054-9 | Delsignore Jeanne Louise |
076974-5 | Dickerson Robert Cushman |
188755-3 | Federowicz Daniel Patrick |
103596-3 | Ferrando-Bort Isidro |
122366-8 | Fredrickson Bruce E |
123838-5 | Freedman Peter A |
170254-7 | Fuchs Marc David |
099215-6 | Godesky Mary T |
187986-5 | Goldstock Leonard Eric |
071619-1 | Gootnick Lester Theodore |
170239-8 | Greenky Brett Bryan |
162177-0 | Greenky Seth S |
196161-4 | Grimm David Charles |
097375-0 | Haake P William |
202111-1 | Hansraj Kenneth Karamchand |
087518-7 | Heineman Robert K Jr |
210288-7 | Hepner Roy A |
072960-8 | Holmblad James E |
128072-6 | Hootnick David Randall |
182146-1 | Israelski Ronald Henry |
120941-0 | Jacobs Richard L |
187047-6 | Katz Richard Lorne |
120136-7 | Kim Kenneth K |
117583-5 | Kim Myung Hyo |
101393-7 | Kunze Wilfried |
213827-9 | Kusior Lawrence Joseph |
206267-7 | Lauritzen Renee Smith |
143383-8 | Lee H Binn |
076629-5 | Lim George |
080344-5 | Mandel Joel E |
168756-5 | Maynard Michael Jude |
134605-5 | McClure Michael G |
204524-3 | Mears Dana Christopher |
120402-3 | Moskowitz Alan |
188446-9 | Murphy Daniel James Jr |
169535-2 | Newman P James |
141333-5 | Nunez Louis David |
198104-2 | Olcott Christopher William |
163383-3 | Ortega Kenneth David |
083883-9 | Pachmakova Weiss Ahinora |
100628-7 | Pearce David F |
120956-8 | Pearson Harold W |
172267-7 | Pedersen Arne K |
133246-9 | Pleger Philip G |
078513-9 | Quinn Brian O Malley |
213245-4 | Rauschenbach Kenneth K |
126879-6 | Reina Charles R |
110026-2 | Riegler Hubert F |
112037-7 | Rinehart Warren T |
100368-0 | Rosenberg Irwin Joseph |
197106-8 | Scerpella Patrick Richard |
137945-2 | Scheinzeit Ronald Steven |
110636-8 | Schrock Robert D Jr |
087062-6 | Sears Kendrick Alan |
103116-0 | Sequeira Denzil A L |
134913-3 | Shankman Gregory Bernard |
199450-8 | Siegrist Stephanie E |
136743-2 | Slavin James A |
167883-8 | Smith William James |
205109-2 | Soyer Adam David |
075450-7 | States David Johnson |
099107-5 | Stetson John Waller |
138770-3 | Stram Richard A |
120449-4 | Striker James E |
047395-9 | Strobino Louis J |
131222-2 | Tebor Gary B |
188429-5 | Thomas James Anthony Jr |
206940-9 | Tigges Russell Gerard |
106756-0 | Toussaint Jon T |
162670-4 | Uhl Richard L |
147849-4 | Vella Ignatius Michael |
127451-3 | Wasyliw Orest M |
137360-4 | Webster Dwight Albert Jr |
190181-8 | Whalen John Thomas IV |
Attachment 2
Data to be submitted semi-annually
Submit information at the individual medical treatment level of detail (i.e. line level, NOT bill level). Data should be submitted based on the dates of transaction for the reporting period. The required elements are listed in the following table:
Data Elements | Sample Record |
---|---|
1. Claimant Identification # (internal) | 42674911 |
2. Claimant SSN# | 09641713 |
3. Claimant Age or DOB (mm/dd/yy) | 58 |
4. Claimant Gender | Male |
5. Date of Accident | 08/17/00 |
6. Part of body injured (code) * | 42 - Lower Back Area |
7. Nature of injury (code) * | 49 - Sprain |
8. Diagnosis Code (ICD-9) | 846 [line level] |
9. Medical Treatment Code (CPT or others) | 99214 [line level] |
10. Medical Treatment Description (non-CPT codes only) | [line level] |
11. Medical type | ME - Office Visit [line level] |
12. Begin Date of treatment | 08/23/00 [line or bill level] |
13. End Date of treatment | 08/23/00 [line or bill level] |
14. Amount of medical treatment billed | 45.78 [line level] |
15. Service provider Tax ID# | 012-34-5678 |
16. Service provider WCB# (if applicable) | 123456-8 |
*Use New York Workers' Compensation Insurance Rating Board Statistical Plan - Part VIII-Statistical Codes
1. Data submission
To facilitate data management, the data elements can be incorporated into three(3) basic tables in order to avoid data redundancy and enable data normalization. These tables should encompass:
Medical transactions - data elements 1, 8, 9, 10, 11, 12, 13, 14, 15,
Claimant Information - 1, 2, 3, 4, 5, 6, 7
Provider Information - 15 and 16
Please provide data files in ASCII-text (delimited) format.
2. Additional information on data elements:
Item#11. Medical type - kindly categorize all medical treatments, into the following, OR use equivalent.
HP - Health provider charge
OH - Hospital Outpatient
IH - Hospital Inpatient
ER - Emergency Room
Etc.
Attachment 3
Contact Information
Carrier Name | _________________________________ |
Address | _________________________________ |
_________________________________ | |
_________________________________ | |
Contact Person | _________________________________ |
Telephone number | _________________________________ |