§ 4806 — Health care facility applications

§ 4806. Health care facility applications. (a) An insurer that offers\na managed care product shall, upon request, make available and disclose\nto facilities written application procedures and minimum qualification\nrequirements that a facility must meet in order to be considered by the\ninsurer for participation in the in-network benefits portion of the\ninsurer's network for the managed care product. The insurer shall\nconsult with appropriately qualified facilities in developing its\nqualification requirements for participation in the in-network benefits\nportion of the insurer's network for the managed care product. An\ninsurer shall complete review of the facility's application to\nparticipate in the in-network portion of the insurer's network and,\nwithin sixty days of receiving a facility's completed application to\nparticipate in the insurer's network, shall notify the facility as to:\n(1) whether the facility is credentialed; or (2) whether additional time\nis necessary to make a determination because of a failure of a third\nparty to provide necessary documentation. In such instances where\nadditional time is necessary because of a lack of necessary\ndocumentation, an insurer shall make every effort to obtain such\ninformation as soon as possible and shall make a final determination\nwithin twenty-one days of receiving the necessary documentation.\n (b) For the purposes of this section, "facility" shall mean a health\ncare provider that is licensed or certified pursuant to article five,\ntwenty-eight, thirty-six, forty, forty-four, or forty-seven of the\npublic health law or article sixteen, nineteen, thirty-one, thirty-two,\nor thirty-six of the mental hygiene law.\n