New York Workers' Compensation HP-1 Medical Bill Disputes: Filing and Evidence Guide

New York's Request for Decision on Unpaid Medical Bill(s), Form HP-1.0, is not a generic collection form. It is an administrative request governed by the Workers' Compensation Board's billing, objection, documentation, and arbitration rules. The outcome often depends less on the outstanding balance alone than on whether the provider can show a valid bill, a mature payment dispute, the correct dispute category, and a record that answers the payer's stated reason for nonpayment.

1. Confirm that the bill entered the New York system correctly

The Board defines a complete medical bill as a CMS-1500 accompanied by the supporting medical narrative. Since August 1, 2025, health care providers in the New York workers' compensation system must submit CMS-1500 billing electronically through a Board-approved submission partner. The Board states that a payer may deny services submitted outside that mandated electronic channel and that the Board will not enforce payment of a noncompliant submission.

• Confirm that the CMS-1500 and narrative were sent through a Board-approved electronic submission partner.
• Retain the electronic acknowledgement showing the payer's receipt date; this date controls the 45-day review period.
• Resolve technical rejections and resubmit before treating the balance as an unpaid-bill dispute.
• Reconcile the provider, patient, WCB case, payer, dates of service, procedure codes, and amounts across the bill and supporting narrative.

2. Apply the 45-day threshold before filing HP-1.0

The Board states that a payer must pay a provider's bill in full or submit the applicable objection within 45 days of submission. A provider should not submit HP-1.0 before 45 days have elapsed. The form also should not be used while a timely legal objection on Form C-8.1B remains unresolved. Valuation objections, including reductions based on the fee schedule or coding, are generally communicated on Form C-8.4 with the related explanation of benefits or explanation of review.

3. Exclude disputes that do not belong in HP-1.0

The unpaid-bill process cannot cure a denied treatment authorization. The Board's FAQ says a provider should not file HP-1.0 for treatment denied through a prior authorization request, adjudication, or conciliation process. Medical-testimony fees also follow a separate request path. The Board further states that it does not adjudicate private PPO contract disputes between providers and provider networks.

• Do not file HP-1.0 to recover payment for treatment that the Board or payer properly denied through the applicable authorization process.
• Do not use HP-1.0 for a medical-witness testimony fee; follow the Board's testimony-payment procedure.
• Do not ask the Board to referee a private PPO contract dispute.
• Do not bill the injured worker for treatment related to the compensable workplace injury; the Board identifies direct patient billing as a potential violation of Workers' Compensation Law section 13-f.

4. Assemble the evidence packet before opening the eForm

For HP-1.0, the Board requires the complete bill and identifies three additional evidence categories: the provider's basis for believing the intervention was medically necessary, payer denial communications if received, and documentation tailored to the specific dispute scenario. The packet should be organized before the request is started so the provider does not rely on the Board to retrieve documents from the case file.

For example, an ambulatory surgery center should include its 3M/EAPG calculation sheet and related prior authorization approvals. A DME vendor should include the purchase invoice for miscellaneous-code items and consolidate the rental period as the Board directs. A provider defending an evaluation-and-management code should explain why the billed CPT code fits the documented work. These are evidence rules, not invitations to submit an entire chart.

5. Understand administrative awards versus arbitration

The Board describes two principal resolution tracks. An administrative award may be created when a Board-authorized provider did not receive a timely valuation objection for services provided in New York. The award is based on the New York workers' compensation fee schedule, subject to the payer's written response and the Board's review.

Arbitration generally applies when the authorized provider received a timely C-8.4 valuation objection, when treatment occurred outside New York, or when the requester is not eligible for Board authorization, such as certain DME suppliers, pharmacies, or out-of-state providers. The classification affects both the evidence and the procedure, so the intake record should identify why the request belongs in one track.

6. Prepare for the HP-6R-D arbitration submission limits

When the matter is referred to arbitration, the Board issues Form HP-6R-D and gives the parties 30 days to respond to the information request. The Board asks each party for a rationale of no more than 250 words and supporting documentation of no more than 20 pages. Late material may not be considered, and excess pages may be disregarded. Form HP-6R-D is used as the cover sheet and does not count against the page limit.

1. State the disputed service, amount, and valuation issue in the first sentence.
2. Use the 250-word rationale to connect the billed code or rate to the Board's fee schedule, Medical Treatment Guidelines, authorization record, and clinical documentation.
3. Select no more than 20 pages that prove the disputed points; do not submit an unfiltered chart.
4. Label each exhibit and cite it directly in the rationale.
5. Use HP-6R-D as the cover sheet and preserve proof of timely delivery to the Medical Director's Office.
6. Reconcile the amount requested to the underlying CMS-1500 and all prior payments.

The Board will not accept a request for an administrative or arbitration award until 30 days after all timely legal-liability issues affecting payment have been resolved. That requirement reinforces the need to separate legal objections from valuation disputes at intake.

7. Track payment and judgment after an award

If the payer does not pay an administrative or arbitration award within 30 days after issuance, the provider may file Form HP-J1 to request consent for judgment and a certified copy of the award. The Board states that those documents must then be filed with the appropriate county clerk within 30 days after execution. The Board also identifies interest of 1.5% for each 30-day period after an unpaid bill becomes due and payable. Apply the current instructions to the actual award and obtain legal review before pursuing judgment enforcement.

Related Millennova Legal resources

Review Millennova Legal's workers' compensation injury-claim and dispute support, the New York workers' compensation state guide, and the separate Texas MFDR filing guide for a comparison of two state-specific medical-fee dispute systems.

Official New York sources