What is MG-1 Form?

Patient > Billing > Charges


A request is sent in MG-1 Form, that a certain procedure or test based on a correct application of the Medical Treatment Guideline needs to be performed on patient. This request is sent by the health care provider for confirmation from the Insurance Carrier/Employer.
CureMD has updated WCB forms according to the latest version released by NY-WCB.
To view this form follow the workflow mentioned, click on the Claims button and then select Wokrer Compensation option from the drop-down menu.
Click on MG-1 add icon to view the updated form.

Add Forms

User can fill in all the required fields on this form to proceed.

MG-1 Form

However, user can check “Designated Contact Information not available” checkbox under Section C to disable the input field “A. Insurer’s designated fax # or email address as provided on the Board’s website” from populating on the MG-1 Report.

Section C

Furthermore, a checkbox “I certify that I am making the above request for authorization. This request was made to the insurer/self-insurer using the following means of same-day transmission (A or B)” is mandatory to Save and Save & Print form.
After certifying the terms and condition user can generate the updated MG1 form by clicking on Save or Save & Print button.

MG-1 Form

On the MG-1 form, NPI No. field is populated with the NPI of attending doctor from Settings. To configure settings to add NPI Number, click here.

MG-1 Form in Crystal Report
Section D,E & F of MG-1 Report
MG-1 Form in Crystal Report

To email, print or fax this report, user can utilize the icons placed on the top of the report.

Print, Email or Fax