For New York workers' compensation treatment or testing that no Medical Treatment Guideline addresses and that costs $1,000 or less, providers file a Non-MTG Under or Equal to $1,000 PAR in OnBoard. This request type had no paper predecessor. The claim administrator responds within 8 business days, and unresolved disagreements are decided through the Board's adjudication process.
The Board-authorized treating provider makes the request, and delegates with their own Board-assigned user IDs can draft it for the provider's review. The claim administrator responds in OnBoard.
Download the current version from the source each time; forms change without notice.
Non-MTG Under or Equal to $1,000 Prior Authorization Request (PAR)
New York State Workers' Compensation Board takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
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It is the OnBoard prior authorization request for treatment or tests that cost $1,000 or less and have no applicable Medical Treatment Guidelines. The Board lists it as a new request type, launched May 2, 2022, with no paper form before it.
Eight business days. The PAR's due date appears on the OnBoard Active tab, and if the claim administrator does not respond within the timeframe, an Order of the Chair may be issued. Deadlines falling on a weekend or public holiday may extend under General Construction Law 25-a.
The request can be escalated within OnBoard, but the Board's training says it is resolved through adjudication. The Medical Director's Office Notice of Resolution process applies to guideline, DME and medication requests, not to non-MTG requests.