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Medical Network Benefits. These courses are not mandatory for authorization renewals but can be taken anytime. In addition to the health conditions on the List of WTC-Related Health Conditions, the Program may also certify health conditions that result from either the treatment of your certified WTC-related health condition or the progression of your certified WTC-related health condition. insurance carrier. Please call the Division of Federal Employees' Compensation (DFEC) at 1-844-493-1966. If we make any significant changes to this notice, a copy of the revised notice will be made electronically available on the WTC Health Program website and you will receive the new notice by mail or email within 60 days. Health Program, including enrollment. pack year is the equivalent of smoking an average of 20 cigarettes, or one full pack, per day for Workers Compensation State Resources - Travelers Insurance If you are deemed eligible for the Program and enrolled as either a Responder or Survivor, you will receive an initial health evaluation. All Program treatment services must be authorized by your Program provider, and in some cases the CCE or NPN Clinical Director and the Program. If your application is denied, you will receive a letter that states why you are not eligible and how you can appeal the decision. ** Claim Reporting Claim Reporting Questions State Forms Claim Information Medical Treatment Cost Containment Information Pharmacy Information Additional Resources supporting documentation. the 9/11 attacks. information for the following purposes: When it comes to your personal health information, you have certain rights. The definitions below are not legally binding. Certificate of Attestation of Exemption (CE-200) Featured Resources Workers Access important information and resources related to your workers' compensation, disability and/or Paid Family Leave benefits. Helps members with cancer identify and access Program cancer-related benefits and services, Use to identify employees that are veterans of the US Armed Forces. (CCE) For Survivors who get WTC-related medications at a pharmacy, please tell your pharmacy to 150 Broadway, Suite 195 Washington, DC 20026. 22-01 - Workers' Compensation Medical Bill Process (WCMBP) System Changes Notice Regarding New System for Electronic Filing Appeals . area based on your category of membership in the WTC Health Program. The Clinical Centers of Excellence and Nationwide Provider Network provide medical care on behalf of NIOSH. You can also view or download this handbook online at www.cdc.gov/wtc/handbook.html. Sometimes, Section 32 agreements release the insurance carrier from having to pay any If your workers compensation case is denied, then the WTC Health Program will directly cover the cost for the medically necessary treatment of your certified WTC-related health condition(s). and criteria for certification, such as maximum time intervals, minimum latency Use if you are signing up for M/C Life Insurance more than 6 pay periods after your start date. aggravating, contributing to, or causing the health condition. Criteria within the WTC Health Programs regulations are established through rulemaking and may only be changed by the Program revising the regulations. satisfied if sent to the designated representative. Various Clinical Centers of Excellence (CCEs) are available to you in the NY metropolitan A long-term care hospital provides care to members with medically complex problems that require an extended stay. organization in the United States. Provider Relations | CorVel Fraud is the intentional deception or misrepresentation that an individual or entity makes knowing that the misrepresentation could result in some unauthorized benefit to the individual, or the entity, or to some other third party. For certification denial, decertification, or treatment authorization denial appeals, your appeal request may also include a request for you or your designated representative to make a 15-minute oral statement by telephone. Only members with a certified WTC-related cancer, cancer medically associated with a certified WTC-related health condition, or chronic pain resulting from a certified WTC-related acute traumatic injury, certified WTC-related muscular skeletal disorder, or a condition medically associated with a certified WTC-related acute traumatic injury or muscular skeletal disorder are eligible for acupuncture services through the Program. Visit www.cdc.gov/wtc/cob.html for more Step 2. A .gov website belongs to an official government instructions on how to schedule your initial health evaluation as a member in the NPN. If you live in an urban area, the NPN will try to find you care within 30 miles of your residence. the State of New York should you need them in the future. the administrative office at that facility. Name of the provider with similar specialty and credentials who will be continuing injured worker's care. contained in your records for the Program. Visit www.cdc.gov/wtc/clinics.html for additional contact information and links to individual clinic websites. Center (WTC) Health Program (the Program). The Program Administrator and medical staff will review the WTC-3 Certification Package submitted by your CCE or the NPN to decide if your health condition can be certified. Members with certified conditions will receive an WTC Health Program Prescription ID card provided by Express Scripts. For more information about latency requirements, you can refer to the Program policies at https://www.cdc.gov/wtc/policies.html. More information on WTC Health Program policies and certification criteria are available at www.cdc.gov/wtc/policies.html and www.cdc.gov/wtc/ppm.html#certification. This registration preserves the right to file for workers compensation benefits through P.O. It is expected to bring thousands of new providers into the NYS Workers' Compensation system. Responders and Certified-Eligible Survivors receive annual monitoring exams in the Program. Your CCE or the NPN will advise you if you may be eligible for a secondary medical review. To fill prescriptions online, track shipments and access your plan information, visit the Accredo website or When the Program receives your appeal, the Administrator will appoint a Federal Official The Board's online Health Provider Search will include only those providers who are authorized. Use to document your Oath of Office, which is required for all appointed officials. documentation must be consistent with the hours or days in your application. to apply again. It is very important that you work closely with the case management team because they will be coordinating your care and should be your first level of contact if an issue arises. . View CCE locations and contact information. The Program may also disenroll a Program member if the members enrollment was based on incorrect or fraudulent information. All non-emergency transportation services must be authorized by the Program or your CCE or the NPN Clinical Director before using the service. Board. This is the form to give your physician to release your medical records for a Workers' Compensation claim. Acts of violence or threats against staff or other patients, including verbal or physical abuse; Rude or vulgar language, including cursing or shouting; May have their care suspended by their CCE or NPN provider; May be required to sign a behavioral agreement outlining what will be expected of them in order to receive care from their provider; May be required to transfer to another CCE or NPN provider; or. Address of your home, workplace, school, daycare center, or adult daycare center and If CVS/Caremark and Optum home delivery pharmacies are in network for your primary insurance, you can have your WTC-related prescriptions delivered through them at no cost. If you are interested in learning more about this, consult your Program provider or case manager. Your CCE or the NPN can advise you on how to find care for any health conditions not certified by the Program. Once approved, will providers need to renew authorization? Hospice care typically lasts 6 months but may be continued longer if your CCE or the NPN Clinical Director confirms care is needed for a longer period of time. Reasons for adding the health conditions(s), including the medical basis for the Begin enrollment New Providers (Individual, Group, Facility or Billing Agent) If you cannot find official supporting documentation, you can submit a letter written by have to travel to multiple specialists instead of a central clinic; General, Pentagon, or Shanksville Responders may transfer between any Responder These services must be authorized by your CCE or the NPN Clinical Director or by the Program. Since the NPN is made up of individual doctors with their own specialties, you may need to New York State Workers' Compensation Board Health Program Member Handbook. Once registered, the deadline to file a VCF claim (and any supporting documents) is October 1, 2090. Some workers decide to settle their workers compensation claims. However, all categories of Program members (except FDNY family members) can be certified for an ATI. EKG (heart test), if medically necessary; and, Spirometry/Pulmonary function testing (breathing test), Chronic respiratory disorder-fumes and vapors, New-onset, and WTC-exacerbated chronic obstructive pulmonary disease (COPD), Reactive airway dysfunction syndrome (RADS), Sleep apnea (medically associated to another airway or digestive disorder), Blood and lymphoid tissue (including CCE, and the NPN; and. or adverse conditions. This allows the Program to coordinate your ongoing care and ensure you receive proper authorization. deceased individual) who were present at the World Trade Center or in the NYC Exposure As a national third party administrator and managed care company, CorVel has posted rosters for California MPN, and Clearinghouse Services in Maine and Minnesota. The WTC Health Program will pay for medically necessary treatment of certified conditions. different form of payment such as your primary insurance or pay out of pocket for the drug. Select the other medical license and review that information. address: U.S. Department of Health and Human Services Please note: The Program may cover earlier or more frequent screenings if you have a higher risk, such as a family history or previous cancer diagnosis. while developing a plan of care specific to your individual needs. State OBN resources Retail: Survivors can get up to a 90-day supply of WTC-related long-term medication(s) at any participating retail pharmacy. In addition, Survivors identified as eligible for medical treatment and monitoring by the WTC Environmental Health Center prior to the Zadroga Act and establishment of the WTC Health You may also file a complaint with the HHS Office for Civil Rights by sending a letter to 200 More information on flu vaccine coverage is available at www.cdc.gov/wtc/flu.html. Claimant Network Benefits - NYSIF Please note: Your Clinical Center of Excellence (CCE) or the Nationwide Provider Network Express Scripts network also includes CVS/Caremark and Optum home delivery pharmacies for Survivors. Your Program provider will help coordinate care of only your certified WTC-related health conditions. a specific medication based on the one that provides a reasonable treatment at the best cost. Complete the required training courses training must be completed before the application can be submitted. Use for assistance in completing a Direct Deposit Form (AC-2772). Please note: The WTC Health Program reserves the right to not cover any of the following services at any time if they are determined not to be medically necessary or do not meet Program policies or coverage guidelines. In addition to this handbook, we continually add and improve Policy and Procedures for Handling Submissions and Petitions to Add a Health Condition to the List of WTC-Related Health Conditions; Policy and Procedures for Adding Non-Cancer Condition to the List of WTC-Related Health Conditions; and. NYSIF has an online medical provider portal for providers to check the status of submitted bills and obtain an electronic explanation of benefits for payments received from NYSIF. information submitted by you. Five copies of the Workers' Compensation Preferred Provider Organization Application must be submitted to: N.Y.S. File A Claim Workers' Comp Benefits Disability Benefits Learn More Employers/Businesses If it is If you have questions, please call the WTC Health Program call center at 1-888-982-4748. CCE or the NPN. Members Complaints and Appeals - New York State Department of Health Reminder: The WTC Health Program is administered by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC) in the U.S. Department of Health and Human Services (HHS). Back. receive annual monitoring exams from the Program as well as medically necessary treatment for your certified WTC-related health conditions. The NPN also includes affiliated and credentialed mental health care providers. form must be filled using the generic medication. Make sure the supporting documentation contains your full name. Apply and upload documentation at https://oasis.cdc.gov (available in English only), Download a paper application at www.cdc.gov/wtc/application.html (available in English, Espaol, Polski, and ), WTC Health Program Get your condition certified: Your WTC Health Program doctor will request They also include other acupuncture services involving heat, pressure, friction, suction, and electromagnetic impulses. Or Email: managedcarecomplaint@health.ny.gov. This review would include any relevant new See examples of WTC-related health conditions. Your cancer specialist is an affiliated provider of the Program and has been approved to provide services to Program members; and, The cancer treatment you receive follows the. New and existing authorized providers, will be expected to re-register with the Board every two to three years, consistent with the renewal of their New York State license. John Howard, M.D. When can new providers who are granted Board-authorization begin to treat injured workers? In some circumstances, a certified condition may be decertified. New York State passed legislation (Senate Bill S9294A ) on September 9, 2022, extending the deadline until September 11, 2026 for filing the Registration of Participation in World Trade Center Rescue, Recovery and/or Clean-up Operations form (Form WTC-12 [PDF, 4 pages, 261 KB] ). for your WTC-related health care needs. Members who are not certified should speak to their primary care physician and use their primary health insurance to receive the flu vaccine. independent of the Program to review your appeal. The following table outlines the minimum latency requirements for cancers covered by the Program: Please note: the WTC Health Program will not consider any exceptions to the latency period. You can also get comprehensive information about your appointments and care through the NPN Member Portal at www.sedgwickwtc.com . Retired FDNY Responders can receive care through the FDNY CCE, the General Responder CCEs, or the Nationwide Provider Network (NPN). Compensation Act of 2010 (Zadroga Act), September 11th Victim Compensation Fund (VCF), U.S. Preventive Services Task Force (USPSTF), https://www.vcf.gov/nyc-map-exposure-zone, www.cdc.gov/wtc/designated_representative.html, See examples of WTC-related health conditions, View more information on certification of WTC-related conditions, For more information see the decertification section, certified WTC-related health condition(s), www.cdc.gov/wtc/ppm.html#medical_acupuncture, https://www.nccn.org/patients/guidelines/cancers.aspx, September 11th Victim Compensation Fund (VCF, James Zadroga 9/11 Health and Compensation Act (Zadroga Act), List of WTC-Related Health The Program covers the cost of treatment for certified WTC-related health conditions only. For more detailed information on eligible groups, supporting documentation, and the Workers' Compensation; Anti-Discrimination Investigations. On January 2, 2011, President Obama signed the For example, an appeal request could argue that the Program incorrectly determined the number of hours the individual worked or volunteered during a covered time period. Workers' Comp Network Solutions Network Solutions . the CCE or NPN and no action is needed by you. Your Program doctor or specialist will prescribe medication for you using the Programs This is known If you are not satisfied with the way your complaint was handled, Member Services Associates are available to address your concerns. Flex Spending Account | Office of Employee Relations If you are not sure if you are already member or need help Health Program doctor may conduct a VCF disability evaluation as needed and appropriate. In some limited circumstances, you can transfer your care to a new CCE even if it has been less than a year since you began care at your current CCE. Sign and notarize the Affirmation A for all nonunion employees. Confirm all the information is correct for the first license (update as needed) and proceed through the form using the continue buttons until you get to the section about Another Medical License. lymphoma, myeloma, and leukemia), Digestive system (including colon Locate a medical network provider in all other states ( select Coventry Integrated Network in the Networks drop-down menu ). The Law is designed to modernize and improve the workers' compensation health care options available to injured workers. Our Top Carriers for Home Health and Companion Care Markel FirstComp One of the largest New York State certified PPOs created specifically with workers' comp in mind. To certify a medically associated health condition, your CCE or NPN doctor must explain how the health condition results from either treatment or progression of the underlying certified WTC-related health condition. Center and other impacted sites can register with the New York State Workers Compensation The Program only provides treatment for the specific conditions on the List of WTC-Related Health Conditions established by the Zadroga Act and Program regulations. This is a chart comparing all benefits and offerings by bargaining unit (union). This is because workers compensation may also provide a financial award for lost wages related to your WTC-related health condition(s).