Revenue Cycle Intelligence
Est. 2020
The Billing Ledger · NY No-Fault · Personal Injury & Workers' Comp
Wednesday, July 29, 2026
Vol. I · No. 8 · Complimentary
Front Page
No-Fault · Verification
Verification Defense Still Needs Proof the Request Went Out
An insurer relying on unanswered verification must show the requests were sent and that no reasonable justification was offered. The 120-day withdrawal rule still needs a properly issued demand behind it.
2026 · 2026 NY Slip Op 50513(U) · Read more →
Workers' Comp · Fee Schedule
New York Proposes Its First Fee-Schedule Overhaul in Years
The Board's Chair proposed amendments across the Official Medical, PT/OT, Behavioral Health, Podiatry and Chiropractic fee schedules — raising E&M payments with offsets elsewhere. The public comment period ran through March 14, 2026.
Jan 16, 2026 · NYS WCB · Title 12 NYCRR · Read more →
Workers' Comp · EDI
Electronic CMS-1500 Billing Is Now Mandatory
NY WCB now requires electronic CMS-1500 submission. Providers may recover up to $1 per bill using CPT 99080; from March 31, 2026, if a bill is paid but the offset is not, they can file Form HP-1.0 for a decision on the unpaid amount.
Mar 31, 2026 · NYS WCB · CMS-1500 · Read more →
Workers' Comp · Forms
RFA-2 eForm Now Mandatory for Insurers
Electronic submission of the Request for Further Action (Form RFA-2) became mandatory March 20, 2026 — part of the OnBoard program that has now processed more than two million prior-authorization requests.
Apr 8, 2026 · NYS WCB · Subject No. 046-1800 · Read more →
Workers' Comp · Analysis
Where Comp Revenue Leaks: The Front-Desk-to-Claim Playbook
In workers' compensation, most denials and lost dollars are decided before billing ever runs — at the schedule, the authorization, and the check-in desk. A field guide to the three leaks that quietly drain a comp practice, and how to close each one.
In workers' compensation, the billing office gets blamed for denials it never caused. By the time a claim reaches billing, its fate is largely sealed — decided earlier, at the schedule, the authorization, and the check-in desk. The most expensive leaks are the ones that never even generate a denial to work.
The first leak is the calendar. Much comp care requires prior authorization, and a visit booked ahead of a valid PAR draws a CO-197 denial — consistently one of the largest categories of preventable write-offs. Tying every authorization-required appointment to an approved request, matched on body part, units, and date range, turns the schedule into the first line of denial prevention.
The second leak is the quietest: patient drop-off. Comp treatment runs as a course of visits, and when an injured worker slips off their cadence, the authorized visits that would have been billed simply never are — while the gap weakens the clinical record carriers scrutinize. It shows up as no rejection at all, which is exactly why it goes unnoticed.
The third leak is bad data at the front. A wrong case number, an unestablished body part, a missing authorization reference — the errors that sink a CMS-1500 are captured at intake, not at billing. New York's all-electronic billing kicks a flawed claim back just as fast as it clears a clean one.
2M+
Prior-authorization requests processed through NY OnBoard
The through-line is that clean comp billing is won upstream. A valid PAR before the visit, a full course of care actually completed, and accurate claim data captured at check-in do more for collections than any volume of back-end appeals. Close the three leaks at the front desk, and the claims that reach billing are simply the ones that get paid.
July 30, 2026 · NYS WCB · MagendaMD Analytics · Read full story →
Workers' Comp · Medical
New Guidance Tightens Handling of Disallowed Cases
Board bulletins this spring clarified handling of disallowed cases and revised Form C-8.1B, the notice used to dispute treatment and bills. Billing on cases without established liability draws fast denials absent the right forms.
Mar 25, 2026 · NYS WCB · Bulletins · Read more →
No-Fault · Case Law
Court: Silence on Verification Can Void a Claim
In Chapa Prods. v MVAIC (2026 NY Slip Op 00342), the Appellate Division held no denial is required when a provider ignores verification demands for 120 days — the claim is deemed withdrawn by operation of Regulation 68.
Jan 2026 · NY App. Div. · 2026 NY Slip Op 00342 · Read more →
No-Fault · Arbitration
Priority-of-Payment Defense Loses Its Teeth
The First and Second Departments held the priority-of-payment rule (11 NYCRR 65-3.15) has no force in arbitration. Because most no-fault disputes are arbitrated, insurers lose a common defense — and clean, timely bills win more awards.
2024–2025 · NY App. Div. · NYSI Reg. 68 · Read more →
More Coverage
Both Lines · Fraud
New Anti-Fraud Units Raise the Documentation Bar
New York's new district-attorney anti-fraud units target medical mills and staged claims across comp and no-fault. The defensive playbook is identical for both lines: authorized providers, documented medical necessity, correct fee-schedule pricing, and airtight verification.
Jun 11, 2026 · NYS WCB · Office of the IG · Read more →
No-Fault · Timelines
The 30-Day Denial and 45-Day Filing Clocks Still Rule
No-fault discipline lives in the calendar: bills must reach the carrier within 45 days of service, insurers must pay or deny within 30 days, and verification requests must be answered — now under a hard 120-day withdrawal rule. Miss a date and the defense is lost before the merits.
Updated 2026 · 11 NYCRR Part 65 · Reg. 68 · Read more →
Workers' Comp · OnBoard
Prior Authorization Moves Fully Onto OnBoard
The Board's OnBoard platform now handles prior-authorization requests (PARs) end to end, topping two million submissions, with a recent enhancement for durable medical equipment. Missing or mismatched PARs remain the top preventable comp denial — scrub every bill against its PAR before release.
Mar 27, 2025 · NYS WCB · OnBoard · Read more →
Insurance Watch · Latest
No-Fault · Litigation
Allstate and GEICO Escalate No-Fault Fraud Suits
Allstate filed two federal RICO suits naming 10 DME companies and 9 individuals, then four more on June 30 against equipment suppliers; GEICO sued 11 DME firms over an alleged $10M no-fault scheme. Insurers say the mills inflate every driver's premium.
Jun 30, 2026 · Insurance Business · Read more →
No-Fault · Rates
PIP Medical Costs Drive New Auto-Premium Hikes
The Department of Financial Services approved multiple statewide auto-premium increases in 2026, driven largely by rising medical costs feeding mandatory no-fault (PIP) claims — and by more frequent severe-weather losses downstate.
2026 · NY DFS · Read more →
Workers' Comp · Carriers
NYSIF Cuts Disability-Benefits Premium 28% for 2026
The New York State Insurance Fund lowered its standard disability-benefits premium 28% for 2026 — from $24.75 to $17.68 per employee per year, with a $60 minimum still applying. Comp loss costs are reset annually by NYCIRB, effective around Oct. 1.
Dec 18, 2025 · NYSIF · NYCIRB · Read more →
Fraud & Enforcement · Latest
No-Fault · Federal Charges
Feds Charge Alleged Ringleader of a No-Fault Network
Federal prosecutors charged the alleged ringleader of a no-fault network that used corrupt doctors, lawyers and financing firms to submit fraudulent insurance claims.
Apr 2026 · Federal Prosecutors · Read more →
No-Fault · Appeals
Appeals Court Revives GEICO's No-Fault Kickback Fight
The Second Circuit revived GEICO's no-fault kickback case, keeping alive a fight over illegal referral and hidden-ownership arrangements that decides whether bills are payable at all.
2026 · U.S. 2nd Circuit · Read more →
No-Fault · Litigation
State Farm's $30M Suit — Then a 5,200-Arbitration Blitz
State Farm's $30M suit accuses a NY practice of inflated ultrasonic-guidance units and full-rate billing for unsupervised mid-levels — then a 5,200-arbitration litigation blitz when claims were cut.
Feb 25, 2026 · Insurance Business · Read more →
No-Fault · Fraud Ring
Judge Voids an Entire Staged-Accident Ring
A NY Supreme Court Justice barred every member of an alleged ring from Integon payouts — eight staged 2023 crashes, 100+ providers named, all routed through two clinics and a single attorney.
Jan 20, 2026 · NY Supreme Court · NICB · Read more →
No-Fault · Fraud Trends
Suspected Auto-Fraud Reports Hit 43,811 — Up 80%
Carriers logged 43,811 suspected auto-fraud reports in 2025 — up 80% since 2020 — fueling Hochul's push to criminalize staged accidents and penalize complicit providers.
2025 · NY DFS · Read more →
No-Fault · Enforcement
Two Charged with Staging Highway Crashes for Cash
DFS charged two men with deliberately staging NYC highway crashes — one allegedly luring participants with cash payouts, the other driving — then billing no-fault for phantom injuries.
Jul 30, 2025 · NY DFS · Read more →
Markets & Metrics · August 2026
Operational dashboards and reporting for Workers' Comp and No-Fault.
Note — All metrics in this section are illustrative sample data for layout. Swap in your live 835 / 277CA / clearinghouse exports (arrays at the top of the page script) to make this a production dashboard.
Clean Claim
92.6%
▲ 0.5 pts MoM
First-Pass Denial
7.4%
▼ 0.5 pts
Days to Pay
38.9
▼ 0.9 days
277CA Reject
4.2%
▲ 0.3 pts
Net Collection
97.3%
▲ 0.2 pts
Top 20 Denial Reasons — This Month
Workers' Comp + No-Fault · ranked by denied claim volume · 3,704 total denials
| # | CARC | Reason | Claims | % Den. | Share | MoM |
|---|
Most Common 277CA Rejections
Front-end acknowledgment rejects
| Status | Reason | Count | Share |
|---|
Average Payment Time by Carrier
Days from clean submit to 835 posting
Most Rejected CPT Codes
Highest denial rate among high-volume codes
| # | CPT | Description | Billed | Denied | Den. % | Top Cause |
|---|
Denial Mix by Category
Share of all denials
Top Prior-Authorization / PAR Mistakes
Preventable auth-related losses
Most Common No-Fault Billing Errors
PIP-specific rejects & delays
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