OnBoard hits two million PAR submissions!

The NYS Workers' Compensation Board (Board) is pleased to share that we have reached our two millionth prior authorization request (PAR) submission via our new business information system, OnBoard!  Even more exciting, with all two million of these submissions:

• Only 8% of PARs have needed escalation to Level 3 review.
• Less than 1% have required a referral for conciliation or a hearing.

This means less processing time is needed for the overwhelming majority of PARs submitted, resulting in more efficient and effective delivery of benefits to injured workers.

Breakdown by PAR type

*The submission of MTG Confirmation PARs is completely optional for health care providers.  Treatment for a given condition that a provider knows to be specifically recommended by the New York Medical Treatment Guidelines (MTGs) is pre-authorized and does not require a Confirmation PAR, except for those relatively few special services for which a Special Services PAR is always required.

OnBoard efficiencies

Since the launch of OnBoard in May of 2022, health care providers and payers have been using OnBoard to submit, review, and approve PARs for medical treatment.  To date, 92% of PARs have been resolved without Level 3 review within 30 days or less, depending on the mandatory response time frame of the PAR type.  For the other 8%, all medication, durable medical equipment (DME), behavioral health, and “carrier unknown” PARs are being resolved on the same or next business day.  Also, all special services PARs are being resolved within a matter of weeks.  These enhancements and diligent response times make for a better stakeholder experience and improve the workers' compensation system as a whole.

Ongoing improvements

Since launching OnBoard, we've made over 75 enhancements to the PAR process and system, and improvement is ongoing.  Recent enhancements include enabling provider delegates to submit PARs on behalf of providers, preventing duplicate HP-1 submissions, enabling grant without prejudice at the Level 1 review, enhancing the Level 2 review process, implementing multi-factor authentication for improved security, and other system processing efficiencies.

Best practice: Avoid unnecessary PARs

Could you be delaying the care of your patient by submitting unnecessary PARs?

As noted above, the submission of MTG Confirmation PARs is completely optional for health care providers.  If you know an intervention (diagnostic or therapeutic) is recommended by the applicable medical treatment guideline, you don’t need to submit it; doing so may unnecessarily delay care.  Similarly, medications in the New York Workers’ Compensation Drug Formulary do not require prior authorization.  When a medication is being prescribed in accordance with the Drug Formulary (i.e., recommended by the applicable medical treatment guideline, listed in the Formulary, consistent with the appropriate A/B/Perioperative Phase, and within the constraints of any Special Considerations), then no Medication PAR is required.  Providers, payers, pharmacy benefit managers (PBMs), and pharmacies should be mindful of this when writing and filling prescriptions.  We estimate that currently, up to 25-30% of Medication PARs submitted are not required.  That means of our 2 million PARs processed, approximately 555,000 MTG Confirmation PARs and 165,000 Medication PARs may not have been needed.  Just imagine the efficiencies in time, process, and cost – and most importantly, faster care for injured workers – that might be realized if some of these optional or unnecessary PARs could be eliminated as we work toward our next million PARs!

Best practice: Payers need to specify denial reasons and provide information needed for approval

Payers who deny Variance, DME, or Medication PARs should be as specific as possible to eliminate any guesswork for treating providers or Medical Director’s Office (MDO) reviewers.  It is inappropriate to deny these PAR requests because they are “Not in the MTGs” or “Not in the Formulary,” because that is the reason they are being submitted and their review requires a determination on medical necessity notwithstanding the MTGs or Formulary.  These inappropriate responses significantly increase the likelihood that the PAR will be approved at Level 3.  Providing a specific reason for the objection gives the treating provider the opportunity to reply to the denial rationale with specificity, and it gives the MDO the opportunity to weigh the arguments on both sides of the request and the denial.  Also, by specifying any needed information that would have resulted in approval of the PAR, the payer avoids unnecessary resubmissions of identical or similar PARs that continue to lack information needed for approval.  Avoiding these resubmissions prevents escalations to Level 2 and Level 3.

To stay informed about OnBoard and other news from the Workers’ Compensation Board, please visit our website wcb.ny.gov.