Get Ny Mg-1.1 2014-2026

The NY MG-1.1 form is used to request optional prior approval for additional treatments or procedures under the Workers' Compensation Board's medical treatment guidelines. This guide provides clear and concise steps to assist you in completing the form online, ensuring that all necessary information is accurately submitted.

Follow the steps to complete the NY MG-1.1 online:

1. Press the ‘Get Form’ button to access the MG-1.1 form and open it in the online editor.
2. Fill in the patient’s details including their name, WCB case number, social security number, and the date of injury.
3. Enter the doctor’s name along with their WCB authorization number and the carrier case number.
4. In section A, specify the treatments or procedures requested. Use the first box to indicate the injury or condition and provide the corresponding guideline reference in the subsequent boxes.
5. Complete the date of service for the supporting medical records in the designated area. Ensure all related documents are attached if they are not already submitted.
6. Indicate the carrier's or employer's response for each treatment requested using the available options: granted, denied, or granted without prejudice.
7. In section C, if applicable, request a review of any denials by providing necessary details and signatures.
8. Finally, review all the information presented, then save your changes, download the completed form, print it, or share it as necessary.

Start completing your NY MG-1.1 form online today to ensure timely processing of your request!