Navigating NYS Medical Treatment Guidelines and PARs: 2026 Compliance Update

May 3

Since 2010, the New York State Workers’ Compensation Board (WCB) has utilized Medical Treatment Guidelines (MTGs) to establish a universal standard of care for injured workers. This system has grown increasingly complex, shifting from paper-based processes to a high-speed digital environment.

For claims administrators and insurance leaders, staying current on these guidelines is a requirement for maintaining compliance and avoiding administrative penalties. Viscardi provides this overview of the 2026 landscape to assist our partners in navigating these requirements effectively.

The Purpose of Medical Treatment Guidelines (MTGs)

The MTGs are evidence-based protocols that serve as the mandatory standard of care in New York. The Board utilizes these guidelines to:

Standardize Care: Ensure all injured workers receive treatment based on medical consensus.
Reduce Disputes: Clarify what is pre-authorized, thereby reducing litigation between carriers and providers.
Improve Outcomes: Facilitate faster recovery and return-to-work timelines through proven clinical pathways.

Expanded Scope of Coverage

The MTGs now encompass a broad range of injury sites and conditions. Current guidelines include:

Musculoskeletal: Neck, Mid/Low Back, Knee, Shoulder, Hip/Groin, Foot/Ankle, Elbow, and Hand/Wrist/Forearm.
Specialized Conditions: Traumatic Brain Injury (TBI), Eye Disorders, and Complex Regional Pain Syndrome (CRPS).
Behavioral & Occupational Health: PTSD, Depressive Disorders, and Occupational Lung Diseases (including Work-Related Asthma).

2026 Regulatory Shifts

Mandatory Electronic Filing:
As of April 8, 2026, the Board no longer accepts paper RFA-2 forms. All Requests for Further Action must be submitted as eForms via the OnBoard system. Additionally, faxed submissions for any claim-related documents are no longer accepted.
PROPOSED - Universal Authorization
As part of the 2026 State of the State initiatives, New York has proposed "Universal Authorization." If enacted this would allow any licensed healthcare provider in good standing to treat workers’ compensation patients without a specific Board-authorization requirement. While having the potential to significantly reduce barriers to care, this change would lead to an influx of providers who may be unfamiliar with MTG compliance, increasing the need for rigorous payer oversight.

Understanding the 3-Level PAR Review Process

The Board utilizes a multi-tiered review system for Prior Authorization Requests (PARs). Navigating these levels correctly is essential to defending a denial.

Level 1: Administrative/Clinical Review: This is the initial review of a provider's request. A Level 1 reviewer may grant in full, grant in part, or deny the request. Find out more about Viscardi’s comprehensive PAR Review solutions
Level 2: Physician Review: If a request is denied or granted in part at Level 1, it may be escalated to Level 2. This stage requires a peer-to-peer clinical perspective to uphold or overturn the initial decision.
Level 3: MDO Final Decision: If the provider continues to disagree with the Level 2 decision, they may escalate to the Board’s Medical Director’s Office (MDO). The MDO issues a final, binding decision.

Prior Authorization Requests (PARs): Deadlines and Requirements

Payers must adhere to the following mandatory response timelines to avoid an automatic "Order of the Chair" approval:

Non-formulary or medical marijuana requests.
Response Time: 4 Calendar Days
Durable Medical Equipment
Response Time: 4 Calendar Days
Confirmation that a test/treatment aligns with MTGs.
Response Time: 8 Business Days
Treatment for non-MTG body parts ($1,000 or less).
Response Time: 8 Business Days
Request to vary from the established MTG standard.
Response Time: 15/30 Calendar Days*
Specific services requiring authorization under MTGs.
Response Time: 15/30 Calendar Days*
Treatment for non-MTG body parts (over $1,000).
Response Time: 30 Calendar Days

*Variance and Special Services allow for a 30-day response if an IME is required; however, the carrier must notify the provider and the Board of the intent to seek an IME within 5 business days.

The Viscardi Advantage: Comprehensive Level 1 & Level 2 Review

Response requirements, particularly the four-day calendar window for Medication and DME, demand a high degree of clinical accuracy. Viscardi manages this risk by providing a professional, clinical review of every PAR, maintaining an average response time of under 2.5 days.

As a URAC-accredited organization, Viscardi is uniquely positioned to handle both Level 1 and Level 2 PAR reviews. Our accreditation signifies that we adhere to the highest national standards for clinical quality and physician reviewer qualifications. By delegating both review levels to Viscardi, carriers and self-insured employers ensure a seamless, compliant, and defensible process from the initial request to the final physician determination.

Ensure your team is compliant with 2026 mandates. Viscardi provides the expert physician and administrative oversight necessary to ensure quality, timely and appropriate care. Contact Viscardi for Level 1 & Level 2 PAR Solutions