New Members: Your Program enrollment welcome letter contains specific information on how to schedule an initial health evaluation/baseline monitoring exam at one of the CCEs or through the NPN. If you have questions, please call the . Medical Network Benefits. Here are the steps you can follow: Step 1. Name of the provider with similar specialty and credentials who will be continuing injured worker's care. You are eligible as a Pentagon or Shanksville, PA Responder if you were an active or retired member of a fire or police department (fire or emergency personnel); if you worked for a recovery or cleanup contractor; or if you were a volunteer that performed rescue, recovery, demolition, debris cleanup, or other related services for at least one day at either the Pentagon site during the period between September 11 and November 19, 2001, or at the Shanksville, PA site during the period between September 11 and October 3, 2001. 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 approved by the CCE or NPN Clinical Director and the WTC Health Program. Try to find documentation that includes as much detail as possible. If you have a problem with any aspect of the service you have received at your CCE, call or visit Medical Provider | U.S. Department of Labor The Clinical Centers of Excellence and Nationwide Provider Network provide medical care on behalf of NIOSH. 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. To streamline the process, the Board has transitioned to a fully electronic online renewal process through the Board's Medical Portal. TTY users should call 1-800-537-7697. The VCF does not compensate for mental health conditions and does not distinguish between responders and survivors. The QualCare . Home health services may be covered for a limited period of time for members who are homebound and require medically necessary home health care services. For information on eligibility, how to download Form WTC-12, and how to file a claim with the New York State Workers Compensation Board, and for any questions about this program, please visit the New York State Workers Compensation Board World Trade Center Assistance site or call 1-877-632-4996. If you are enrolled with the Registry, you received a first survey and now receive periodic The Program has partnered with Express Scripts to provide prescription benefits for members with certified WTC-related health condition(s). The Program covers diagnostic services, such as blood work, imaging studies, biopsies, and specialty consults that your Program doctor needs to determine if you have a cancer that is covered by the Program. If you receive a bill for WTC-related care, please call your CCE, the NPN, or the Program call center so that the issue can be addressed. In addition, Responders identified as eligible for monitoring through Mount Sinai Hospital or FDNY prior to the Zadroga Act and establishment of the WTC Health Program may be enrolled as WTC Responders in the Program. You may have a condition that you believe is the result of your 9/11 exposure but is not included on the List. You may also file a complaint with the HHS Office for Civil Rights by sending a letter to 200 Medical Portal open_in_new (Link opens in a new window)-New York State Workers' Compensation Board. Learn more about NCCN guidelines at https://www.nccn.org/patients/guidelines/cancers.aspx . This is a chart comparing all benefits and offerings by bargaining unit (union). (CCE), James Zadroga 9/11 Health and The definitions below are not legally binding. If you have a certified condition you may also be eligible to use either Express Scripts Pharmacy or another home delivery to have your medications mailed directly to your home. As of January 1, 2020, licensed clinical social workers, nurse practitioners, acupuncturists, physician assistants, occupational therapists and physical therapists may apply to become Board-authorized providers. Center and other impacted sites can register with the New York State Workers Compensation They also include other acupuncture services involving heat, pressure, friction, suction, and electromagnetic impulses. New provider types, if authorized, can begin treating injured workers on January 1, 2020. programs and private insurance companies. Conditions which meet these Use for assistance filling out the Employment Eligibility Verification Form (I-9). Provider Enrollment | One Call Medical Provider This page contains numerous resources for medical providers. You can contact the Programs call center at 1-888-982-4748. Medical Providers | U.S. Department of Labor For more information about the Registry, please contact them directly at wtchr@health.nyc.gov. If you are certified and do not receive this ID card, or have questions about your pharmacy benefits, please call Express Scripts at 1-800-935-7179 or contact your CCE/NPN. Partners and LLC must be included at a minimum of $45,500 and a maximum of $135,200 for 2023. someone who can confirm your eligibility details (known as a third-party attestation). If you live in a rural area, the NPN will try to find you care within 75 miles of your residence. The Zadroga Act established or reauthorized the following three programs that help those Due to a technical issue, mailed Board documents may be temporarily delayed. Complete the required training courses training must be completed before the application can be submitted. Program representative to learn more about those benefits, seek assistance applying for 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. (1) you have a health condition that is on the List of WTC-Related Health Conditions, This allows the Program to coordinate your ongoing care and ensure you receive proper authorization. This transition plan shall include the following: The resignation letter and transition plan shall be sent to the Board's Medical Director's Office (MDO) at the address below at least thirty (30) days before the effective date of the provider's resignation. identify specific benefits for which you might be eligible. a Certified-Eligible Survivor. Your Program doctor or specialist will prescribe medication for you using the Programs Please note: Your Clinical Center of Excellence (CCE) or the Nationwide Provider Network The Zadroga Act allows only one initial health evaluation to be paid for by the Program. The goal of case management is to share resources that allow you to return to your maximum requirements are then certified by the WTC Health Program. Existing user? Please Note: Many of the terms here are formally defined in the Zadroga Act and Program regulations. CCE or the NPN. Whenever feasible, providers are encouraged to provide to the MDO and initiate a transition plan at least ninety (90) days prior to their resignation date. More information about the VCF is available here. Helps you identify appropriate care for medical and mental health conditions or medications This review would include any relevant new In addition to this handbook, we continually add and improve By law, you have the right to: By law, the WTC Health Program must have your written permission (authorization) to use or share your personal health information for any purpose that is not set out in this notice, including certain uses or disclosures of psychotherapy notes. If you have a problem with the service you have received with the NPN, you may call the NPN at 1-800-416-2898. applicable to all Program applications and/or members; or, The exclusion or absence of a health condition from the. You do not need to call your CCE or the NPN before receiving emergency medical care. Ask to speak to a customer service representative about the WTC Health Programs HIPAA privacy notice. Download NYS Health Insurance Program NYSHIP Opt-out Attestation Form (PS-409) You will not lose legal rights by registering. For more information, visit the Pharmacy Benefits page at www.cdc.gov/wtc/pharmacy.html. For more information on generic drugs, talk to your CCE or NPN provider. in the WTC Health Program, including copies of factual and medical evidence U.S. Department of Labor. . Prior to this law taking effect, only physicians, chiropractors, podiatrists, and psychologists were able to be authorized to treat injured workers. Use to identify and withhold the correct New York State, New York City, and/or Yonkers Tax. The Zadroga Act Qualified employees who work at least 35 hours per week are eligible for a bonus of $1,500. you would like to transfer to a different CCE or another doctor in the NPN. This is the form to give your physician to release your medical records for a Workers' Compensation claim. hours of your scheduled appointment time so that the appointment can be offered to Failure to provide a transition plan may result in a provider's referral to the Office of Professional Medical Conduct or Office of the Professions, as appropriate, to investigate potential professional misconduct. listed above (known as a first-party attestation). Travel expenses are available on a limited basis under the Program for members of the NPN. documentation must be consistent with the hours or days in your application. In order for your treatment to be covered by the Program, you must receive the treatment from a WTC Health Program affiliated provider. We understand that you may have difficulty obtaining documentation. More information on the appeal process is available at www.cdc.gov/wtc/appeals.html. Note: The list below is not exhaustive. If not, a staff person can help you to get the care you need at a Federally Qualified Health Center or other community health center that offers more affordable care options for you. Enrollment in the WTC Health Program does not automatically register you or file a The final step to apply to the WTC Health Program is to complete the application and send it in with your supporting documentation. information on our website, including: We know that you depend on the WTC Health Program for high-quality, compassionate care When it comes to insuring the safety of your employees, experience the Comp Alliance difference. The Administrators If a Responder has a workers compensation claim for the certified condition, then workers compensation is the primary payer and the Program pays the remainder of the costs. Rensselaer, NY 12144 ATTN: WTC Health Program, HIPAA Complaint. You can call 1-888-982-4748 to get further information about matters covered by this notice. 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. locations throughout the New York (NY) metropolitan area. This form is for your physician to fill out when your family member has a serious medical condition and you are filing for FMLA. If a member is a minor, a parent or guardian may act on the members behalf. Espaol [PDF, 1 page, 56 KB, April 2023], National Institute for Occupational Safety and Health (NIOSH), https://www.cdc.gov/about/leadership/leaders/niosh.html, Clinical Center of Excellence Online Medical Provider Portal - NYSIF also include details about: Both types of attestations must contain the required specific information and be hand signed by the writer as truthful under penalty of law. Disagreement with Program policy is not a valid reason for secondary review. The World Trade Center (WTC) Health Program pays for all medically necessary treatment for your certified WTC-related health condition(s), as well any certified medically associated health conditions, as long as the treatment is provided by a WTC Health Program affiliated provider. Health Program Member Handbook. This will include information on scheduling your first exam and how to sign up for the NPN Member Portal. such as an attorney, family member, advocate, or friend, unless that individuals service as a Your 9/11 exposures are substantially likely to have been a significant factor in The Program provides Responders yearly follow-up exams called annual monitoring exams, whether you are sick or not. For more information about the Programs recoupment policy, refer to the Policy and Procedures for Recoupment: Lump-Sum Workers Compensation Settlements online at Don't have an account? work. Residential treatment for substance use disorder is not covered by the Program. and criteria for certification, such as maximum time intervals, minimum latency The WTC Health Program will collect and use your personal health information OWCP; Medical Providers . and complaints. New York: Workers' Compensation | AIG US Please make sure your application includes your full legal name and date of birth. Write down a list of any medications you are currently taking; Be prepared to talk about your exposure, work history (if applicable), and your current symptoms. The letter will explain why your condition was decertified and provide you with information about how to appeal the decision if you would like to do so. New Members: Shortly after you receive your Program welcome letter, you will receive a new member packet from MCA-Sedgwick. The transition plan shall list all injured workers under the provider's care, together with the authorized provider(s) who will be assuming injured workers' care. To designate a representative, you must notify the Program in writing using the Designated Representative forms available at www.cdc.gov/wtc/designated_representative.html. documentation demonstrating the name change (such as a marriage certificate). Survivors should have symptoms of a WTC-related health condition before applying to the Program. Serve as your representative in all matters pertaining to your membership in the WTC John Howard, MD, MPH, JD, LLM, MBA, is board-certified in internal medicine and Any actions taken by the Program in response to the Administrators final decision. physical and mental health conditions have persisted in 9/11-exposed populations, and or adverse conditions. If you have questions about maximum time interval for your aerodigestive disorder, speak to your Program doctor. The Program directly pays for all monitoring, treatment, and medication costs of a certified WTC-related health condition for Responders with one exception. When the Program receives your appeal, the Administrator will appoint a Federal Official All Program treatment services must be authorized by your Program provider, and in some cases the CCE or NPN Clinical Director and the Program. Please refer to instructions for completing this form. The Program will closely monitor any fraudulent activity including the submission of fraudulent information in support of a claim of eligibility or for necessary and covered services, fraudulent misuse of the Program by health care providers participating in the Program, and submission of claims for services not provided or needed as claimed. These types of behavior include, but are not limited to: Depending on the particular circumstances, members who engage in such behaviors: The Program strives to provide high-quality, compassionate care for members WTC-related brand name drugs. Where can injured workers find a listing of Board-authorized providers? View CCE locations and contact information. paid by workers compensation, like the costs of medical treatment and medications for certified WTC-related health condition(s). requirements must be reflected in your supporting documentation. Sign up for digital downloads on the How to Register to Download Claim Notices page. 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 Expand All | Collapse All Medical Bill Processing Portal Medical Bill Processing Portal If this is the case, you may petition the Administrator to add a health condition to the List. Annual lung cancer screening is available to eligible members aged 50 to 80 years who have (CCE) You will be notified in writing of the following: Once the Administrator has made a decision on your appeal, it is final. individuals involved in a members care. The following categories are outlined by the Zadroga Act and include examples of conditions within each category. The Board's online Health Provider Search will include only those providers who are authorized. The Program finds that your health condition was mistakenly found to be medically associated with a WTC-related health condition. To initiate the process, you must send a letter to the CCE/NPN Clinical Director or designee which clearly indicates your request to obtain a secondary medical review. The services must then be provided by an acupuncture provider in the respective CCE or NPN network. Albany, New York 12237. the appropriate activity, location, time period, hours requirement, and covered activities as We Understand Work Comp. For Survivors, this provider should also be in your primary health insurance network. Search options: Search for a provider or IME by specialty or last name in a geographical area Verify provider or IME by using their NPI or license number NOTIFY THE ACCIDENT REPORTING SYSTEM (ARS) at 1-888-800-0029 to report a work . MetraComp | Coventry If you are a new provider to the Medical Portal, you must first sign up for access to the Medical Portal. Fax Number: 1-877-646-5308. Workers Compensation State Resources - Travelers Insurance insurance carrier. NYS . If you live in an urban area, the NPN will try to find you care within 30 miles of your residence. Workers' Comp Network Solutions Network Solutions . For example, the hours or days in your supporting Multiple criteria must be met in order for these If you need treatment services that require a Level 2 or Level 3 Prior Authorization, your Program provider will request the authorization for you. More information on acupuncture coverage is available at www.cdc.gov/wtc/ppm.html#medical_acupuncture. If you are not satisfied with the way your complaint was handled, Member Services Associates are available to address your concerns. Disclaimer: This handbook is not a legal information submitted by you. Transportation and lodging expenses for medically necessary care within the U.S. may be It is expected to bring thousands of new providers into the NYS Workers' Compensation system. medically necessary services needed to treat your certified WTC-related health condition(s) A qualified employee is eligible for up to two vesting periods per employer. May be subject to other appropriate actions, including involvement of law enforcement authorities as necessary. ET on Thursday, July 20, 2023, there will be an estimated 1 to 2-hour period . Workers' compensation is state regulated and some states have legislation that requires online access to listings for healthcare providers. This is known Since the NPN is made up of individual doctors with their own specialties, you may need to The WTC Health Program only covers medically necessary healthcare services within the United States and its territories, including the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, and the Trust Territory of the Pacific Islands. At other CCEs, these services are provided by affiliated This form is for your physician to fill out when you (the employee) are filing for FMLA for a serious medical condition. Once youve determined your eligibility and gathered your documentation, the next step is to apply. Use this form to change your name, address, email address, or phone number. If the drug is not approved but you would like to continue using it, you will have to use a A Program member may initiate their own disenrollment from the Program at any time and for any reason. Coordination of Benefits is a process that helps determine who pays a medical bill first when there is more than one potential payer. File A Claim Workers' Comp Benefits Disability Benefits Learn More Employers/Businesses This insert contains updates and additions to the print version of the Member Handbook. Parents and Providers Resources for Parents and Families You can update your information with the Board at any time by logging into the Medical Portal and selecting the Update Authorization Information link . go to more than one provider to receive care for each of your certified WTC-related health All Program health care providers and staff share responsibility for assuring member Request authorization type change - e.g., you are currently authorized to treat and now you want to apply to become authorized to perform Independent Medical Examinations as well (only applicable for a Physician, Chiropractor, Podiatrist or Psychologist).
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