Seamless and efficient utilization review

Leveraging Genex Utilization Review in New York

New York’s OnBoard Limited Release transitions key utilization review processes online streamlining operations and increasing efficiency. Learn about the updated regulations, how to stay compliant, and about our flexible options designed to fit your needs.

Introduction

In the spring of 2022, the New York State Workers’ Compensation Board (WCB) rolled out OnBoard: Limited Release which transitioned key utilization review processes from paper to online for health care providers, payers and other stakeholders. These new requirements presentan opportunity for payers and managed care providers to increase efficiency, improve injured employees’ care, and save time and cost by eliminating manual tasks. 

The new Prior Authorization Request (PAR) process in OnBoard replaces the legacy MG-1, MG-2, C-4 Auth and Drug Formulary Medical Portal processes by requiring electronic submission through OnBoard. As of August 2023, Onboard hit 1 million PAR submissions.

The updated utilization review process has three levels of review with different user types at each level. OnBoard dictates which decisions, information and options can be utilized for levels one and two:
  • Level 1 can be anyone designated by the payer 
  • Level 2 is performed by the payer’s physician (peer reviewer)
  • Level 3 is performed by the Medical Director’s Office (state appeal)

Genex offers both Level 1 and Level 2 reviews with service options to support your customized New York utilization review needs:

Genex as your medical review organization (MRO) 
Genex as your overflow partner for Level 1 or Level 2

Program Features

Adherence to New York required turnaround times
Supported by a team of clinical staff, including a national medical director
Ease of use through the management of the Onboard electronic process
Decisions uploaded to Onboard and communicated to the claims professional
Decisions are also recorded in Genex systems for client reporting
Decisions are transmitted to Enlyte bill review

To ensure appropriate
adjudication of the medical bills
(for applicable clients)

Compliance team closely monitors OnBoard updates

80 New York Licensed Peer Reviewers

  • Occupational medicine
  • Internal medicine
  • Emergency medicine
  • Pain management
  • Psychiatry
  • Orthopedic surgery
  • Physical medicine and rehabilitation

Common Treatments Addressed by Utilization Review

  • Outpatient and inpatient surgery (elective or non-emergency)
  • In-patient admissions (non-emergency)
  • Work hardening/work conditioning
  • Functional restoration programs
  • Any investigational or experimental service or device
  • Psychological testing and psychotherapy
  • DME > $500 per item (either purchase or cumulative rental)
  • Medications
  • Compliance team closely monitors OnBoard updates