Inside the Digital Shift of New York Workers’ Compensation

On October 18, 2024, the New York Workers' Compensation Board (WCB) held its first in-person conference since 2019, drawing in a sold-out crowd eager to reconnect and discuss the latest advancements. This conference spotlighted the success of the rollout of OnBoard: Limited Release (OBLR) and provided information on forthcoming enhancements.

The Success of OBLR

In spring 2022, the New York WCB launched OBLR, transitioning utilization review processes online for healthcare providers, payers, and stakeholders. This shift became crucial for payers and managed care providers, promising increased efficiency, enhanced care for injured employees, and cost savings by reducing manual tasks. The Prior Authorization Request (PAR) process replaced the legacy MG-1, MG-2, C-4Auth, and Drug Formulary Medical Portal processes, requiring electronic submissions.

Since its inception, over two million PARs have been processed , underscoring the Board’s commitment to improving electronic access and phasing out paper processes. Notably, OBLR is moving towards full digital authorization, eliminating inefficient paper processes and allowing for real-time access to case information. This digital approach decreases duplication and errors, offering reliable data for decision-making.

The modernization strategy aims for faster resolutions through electronic submissions, real-time data access, increased automation and a streamlined system that enhances response times for stakeholders. The Board’s modernization goals focus on three core areas:

• Reducing risk: Eliminating technical debt from older systems.
• Increasing efficiencies: Through faster, more accurate processing of PARs.
• Driving better outcomes: Ensuring that stakeholders, from providers to administrators, benefit from a reliable, data-rich system.

Key Insights from PAR Data

The conference highlighted detailed data around PARs. Medication-related PARs topped the volume charts, with over 670,000 processed since OBLR began. Many of these requests pertain to topical agents such as diclofenac and lidocaine, aligning with the shift towards non-opioid treatments. Due to reforms, opioid prescriptions have decreased significantly, showcasing the positive impact of the Board’s initiatives.

The other major PAR categories include:

• MTG Variance PARs: Over 600,000 processed, allowing for specific deviations from Medical Treatment Guidelines when necessary.
• MTG Confirmation PARs: Over 550,000 processed, though these are optional for health care providers.

The Board announced that 92% of PARs have been resolved without Level 3 review within 30 days or less. The streamlined electronic submission has also reduced the backlog of Level 3 (L3) PAR reviews, significantly decreasing decision turnaround time to just 2-3 weeks, underscoring the efficiencies of the modernized system.

Best Practices for PAR Submission

Dr. James Tacci, the Board’s Medical Director, provided invaluable guidance to help providers navigate the OBLR system effectively and avoid unnecessary delays in care:

• Avoid Unnecessary PARs: Providers should refrain from submitting Medical Treatment Guidelines (MTG) confirmation or formulary PARs when treatment aligns with guidelines or formulary lists.
• Accuracy in Submission: Ensuring the correct PAR type and attaching thorough documentation will expedite processing and reduce backlogs.
• Clear Clinical Rationale: Providers are encouraged to provide clear clinical justifications within the medical narrative, especially for escalated reviews.

By following these best practices, providers can streamline their interactions with the Board, enabling more efficient and effective care delivery for injured employees.

New Features for Efficiency and Improved Security

In developing OBLR, the NY WCB has engaged extensively with internal and external stakeholders to identify pain points and improve system requirements. This collaborative approach has led to over 75 enhancements since the initial rollout, addressing critical needs across the stakeholder spectrum. Notable improvements include:

• Multi-factor authentication to strengthen security
• Enabling grant without prejudice at the Level 1 review
• Enhanced delegation capabilities allowing delegates to submit PARs
• Prevention of duplicate Form HP-1.0 submissions, reducing administrative burden

Additionally, the WCB added the ability to submit forms electronically. eForms provide a practical solution to simplify the submission process through a user-friendly, wizard-based web solution. This approach makes it easy to gather the necessary data for Board filings while allowing users to attach supporting documents. The technology includes data validation features that enable immediate corrections to be made, ensuring submissions are accurate before they are directly placed into the electronic case folder. For those who opt in, the system sends text or email notifications to keep them informed about their case status. Additionally, eForms are automatically routed to the appropriate Board unit for review, ensuring each submission is handled efficiently. eForm submission improves the timeframe from an average of 8 days (paper) to 10 seconds (electronic) through eCase.

Planned Updates for Enhanced User Experience

Looking ahead, the NY WCB is set to introduce several impactful features:

• PAR Withdrawals: Soon, stakeholders will be able to withdraw PARs as necessary, offering greater flexibility in managing requests.
• Expanded eForm Implementations: Both RFA-1LC (late 2024) and RFA-2 (late 2025) will launch to further support electronic submissions.
• Modernized Claims System (eCase): Enhancements to eCase will address existing challenges, such as easier case file access for providers, a timeline-based case information view, and bulk case file downloads.

Additionally, three electronic submission methods are being developed to meet varying user needs:

• eForms: Adding new eForms to guide users through form completion in a structured manner.
• XML Submissions: Secure file transfer protocol (sFTP) will soon allow stakeholders to submit XML files directly.
• API Submissions: Designed to facilitate automatic data exchange between systems, APIs are expected to eliminate manual entry errors and expedite case file updates.

This approach ensures adaptability, allowing stakeholders to interact seamlessly with the Board while driving process efficiency and minimizing errors.

A Collaborative Future for New York Workers' Compensation

The NY WCB’s 2024 conference underscored the significant strides made in modernizing New York’s workers' compensation system, setting a standard for efficiency, transparency, and data-driven decision-making. As the OBLR system continues to evolve, its impact will be felt by all stakeholders—from providers to claims administrators. The Board’s commitment to stakeholder collaboration and system enhancements reflects a shared vision for a streamlined, accessible, and efficient workers' compensation system.

As we look to the future, it is clear that the digital transformation of New York’s workers' compensation system has only just begun. With an ambitious roadmap for continued modernization, stakeholders can expect a system that is better equipped to meet their needs while delivering quality care for injured employees. To stay up to date with pertinent news from the NY Workers’ Compensation Board, please contact your Enlyte client success manager.