This text of New York § 345 (Health care claims reports) is published on Counsel Stack Legal Research, covering New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
§ 345. Health care claims reports. An insurer authorized to write\naccident and health insurance in the state, a corporation organized\npursuant to article forty-three of this chapter, or a health maintenance\norganization certified pursuant to article forty-four of the public\nhealth law shall report to the superintendent quarterly and annually on\nhealth care claims payment performance with respect to comprehensive\nhealth insurance coverage. The reports shall be submitted in the manner\nand form prescribed by the superintendent after consultation with\nrepresentatives of insurers and health care providers but at minimum\nshall include the number and dollar value of health care claims by major\nline of business and categorized as follows: health care claims\nreceived, health care claim
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§ 345. Health care claims reports. An insurer authorized to write\naccident and health insurance in the state, a corporation organized\npursuant to article forty-three of this chapter, or a health maintenance\norganization certified pursuant to article forty-four of the public\nhealth law shall report to the superintendent quarterly and annually on\nhealth care claims payment performance with respect to comprehensive\nhealth insurance coverage. The reports shall be submitted in the manner\nand form prescribed by the superintendent after consultation with\nrepresentatives of insurers and health care providers but at minimum\nshall include the number and dollar value of health care claims by major\nline of business and categorized as follows: health care claims\nreceived, health care claims paid, health care claims pended and health\ncare claims denied during the respective quarter or year. The data shall\nbe provided in the aggregate and by major category of health care\nprovider. The reports should address any patterns or suspected areas of\nrevenue maximization that may have contributed to the number of denials.\nThe reports shall be due to the superintendent no later than forty-five\ndays after the end of the respective quarter or year and shall be made\npublicly available including on the department's website. The\nsuperintendent, in conjunction with the commissioner of health, may\npromulgate regulations requiring additional reporting requirements on\ninsurers, corporations, or health maintenance organizations or health\ncare providers to assess the effectiveness of the payment policies set\nforth in this section, which may be informed by the administrative\nsimplification workgroup authorized by subsection (k) of section three\nthousand two hundred twenty-four-a of this chapter.\n