New York Workers' Compensation Prior Authorization: OnBoard PAR Guide

A prior authorization dispute is not the same as a medical-bill dispute. The PAR process addresses approval for proposed medication, equipment, treatment, or testing. Form HP-1.0 addresses an unpaid or underpaid bill after services were rendered. A provider should identify the dispute stage before choosing a workflow, deadline, or evidence packet.

This guide reflects New York Workers' Compensation Board materials available on September 25, 2026. It is operational information for providers and reimbursement teams; it does not decide medical necessity, compensability, claim establishment, or entitlement to payment in a specific case.

OnBoard PAR workflow at a glance

1. Choose the correct PAR type

The Board's provider guidance identifies seven OnBoard PAR families. Selecting the correct family is the first quality gate because different response periods and review paths apply.

For an MTG variance or MTG special-services request, a claim administrator that intends to use an independent medical examination or review of records must notify the provider and Board through OnBoard within five business days and still issue its response within 30 calendar days after receipt. The Board notes that General Construction Law § 25-a can move a deadline that ends on a Saturday, Sunday, or public holiday to the next succeeding business day.

2. Confirm that the submitter is eligible

Board-authorized and out-of-state health care providers submit PARs through OnBoard; paper PAR forms are no longer accepted by fax, email, or mail. The permitted PAR types vary by profession. Physicians may submit all seven types, while other provider categories have narrower permissions. Physical therapist assistants, occupational therapy assistants, residents, and fellows must work through the supervising provider or physician for requests outside the MTGs or Drug Formulary.

Each provider and delegate needs an individual Board-assigned user ID. A group cannot share one credential. A provider may authorize delegates to help draft and submit within the roles assigned through Health Care Provider Administration, but the final submission carries an attestation equivalent to the provider's electronic signature.

3. Build a clinically reviewable submission

OnBoard accepts structured entries and attachments. The Board directs providers to enter or attach relevant clinical information, including narratives, progress notes, symptoms, the justification for initial or continuing care, diagnostic testing, equipment details, contraindications, adverse effects, and—when applicable—the effectiveness of prior treatment or medication.

1. Identify each requested treatment, test, medication, or DME item precisely; avoid a general plan-of-care description.
2. State the accepted or alleged body part and diagnosis that connect the request to the claim.
3. For an MTG request, cite the guideline recommendation or identify why a variance is medically necessary.
4. Document objective findings, functional limits, treatment history, response, and material changes.
5. For medication, address Formulary status, prior therapies, adverse effects, and the clinical reason for the requested drug.
6. For DME, identify the item, quantity, duration, and whether it appears on the DME Fee Schedule with a PAR designation.
7. Attach the current records actually relied upon and preserve an exhibit list.

4. Preserve the submission record

OnBoard routes the completed PAR to the claim administrator associated with the claim. The provider should download the submitted PDF and retain the PAR ID, submission timestamp, line items, attachments, claim-administrator identity, and claimant-notification record. Those items establish what was requested and when the response period began.

• Capture the OnBoard confirmation and submitted PDF.
• Maintain a separate deadline field for every PAR when one submission produces multiple requests.
• Record all status notifications and dashboard changes.
• Save requests for additional information and the provider's response.
• Notify the claimant when submitting or escalating a PAR, as the Board requires.
• Do not assume that a system email contains the decision; open the dashboard and retrieve the actual document.

5. Track the payer deadline correctly

The system tracks the mandatory response period. A claim administrator may request additional information inside OnBoard, but the Board states that the request does not pause or extend the mandatory response period, and the provider is not obligated to respond. Operationally, a provider may still respond when the information is material, while preserving the original deadline and documenting exactly what was added.

If the claim administrator does not respond within the applicable period, the Board may issue an Order of the Chair. The provider should not treat silence as an informal approval; it should preserve the deadline evidence and monitor OnBoard for the formal status or order.

6. Separate administrative and medical denials

For non-medication PARs, a Level 1 approval ends the payer review. A partial grant or medical denial automatically proceeds to the payer's Level 2 reviewer, who must be a physician and must give the medical rationale within the original PAR response period. A Level 1 reviewer may issue an administrative denial without medical review.

That classification matters. Eligible medical-necessity denials may be escalated to the Board's Medical Director's Office for Level 3 review. Administrative denials generally are not eligible for Level 3 review, except medication PARs. A denial of a non-MTG request over $1,000 is addressed at a priority hearing rather than ordinary MDO review. If the disputed issue is claim establishment, causal relationship, or another legal question, the injured worker may need Board adjudication rather than a medical-necessity escalation.

Medication PARs use an opt-in escalation sequence

For medication requests, the provider receives the Level 1 decision and chooses whether to request Level 2 review by the claim administrator's physician. After Level 2, the provider may accept the result or request Level 3 review by the MDO. This differs from the automatic Level 2 routing applied to non-medication partial grants and medical denials.

7. Build the escalation record

• Read the actual denial and identify whether it is administrative, medical, burden-of-proof, or a legal issue.
• Compare the records listed by the reviewer with the submitted packet.
• Address the specific rationale rather than resubmitting the same general narrative.
• For an MTG dispute, connect the clinical facts to the guideline or variance standard.
• Preserve the Level 1 and Level 2 determinations, timestamps, and notices.
• Use the escalation control in OnBoard only for a PAR type and denial category eligible for that review.
• Calendar any claimant or counsel adjudication step separately from the provider's medical-necessity workflow.

8. Understand what an MDO decision resolves

The Board states that an MDO medical-necessity determination for MTG-related procedures, DME, or medication is final at that administrative level. The claim administrator may not later deny payment on the same medical-necessity ground. The determination does not guarantee payment or resolve outstanding legal issues such as whether the injury is work related. Those issues must be raised in the initial payer review and handled through the proper adjudication path.

If the injured worker or legal representative disagrees with an MDO resolution involving medication, DME, MTG variance, or MTG special services, the Board identifies Form RFA-1W or eForm RFA-1LC as the route to request adjudication. Provider teams should coordinate without assuming they independently control the claimant's legal appeal.

Provider quality-control checklist

• Correct PAR family and provider eligibility confirmed.
• No substantially similar PAR is already pending.
• Every line item is specific and clinically supported.
• Applicable MTG, Formulary, DME schedule, or non-MTG basis is documented.
• Submission PDF, attachments, PAR ID, and timestamp are preserved.
• Claimant notification is documented.
• Four-day, eight-business-day, 15/30-day, or 30-day response period is calendared.
• Requests for information do not overwrite the original deadline.
• Administrative, medical, and legal denial grounds are separated.
• Level 3, priority-hearing, or adjudication route is selected from the actual denial type.
• Final authorization is retained for treatment and later billing operations.

Related Millennova Legal resources

Use Millennova Legal's workers' compensation dispute support and New York workers' compensation guide for broader jurisdiction context. If treatment has already been billed and the dispute concerns nonpayment rather than authorization, use the New York HP-1 medical-bill dispute guide. For a different state's medical-necessity review process, see the California utilization review and IMR guide.

New York primary sources