§ 4406-H — Health care facility applications

§ 4406-h. Health care facility applications. 1. A health care plan\nshall, upon request, make available and disclose to facilities written\napplication procedures and minimum qualification requirements that a\nfacility must meet in order to be considered by the health care plan for\nparticipation in the in-network benefits portion of the health care\nplan's network. The health care plan shall consult with appropriately\nqualified facilities in developing its qualification requirements. A\nhealth care plan shall complete review of the facility's application to\nparticipate in the in-network portion of the health care plan's network\nand shall, within sixty days of receiving a facility's completed\napplication to participate in the health care plan's network, notify the\nfacility as to: (a) whether the facility is credentialed; or (b) whether\nadditional time is necessary to make a determination because of a\nfailure of a third party to provide necessary documentation. In such\ninstances where additional time is necessary because of a lack of\nnecessary documentation, a health care plan shall make every effort to\nobtain such information as soon as possible and shall make a final\ndetermination within twenty-one days of receiving the necessary\ndocumentation.\n 2. For the purposes of this section, "facility" shall mean a health\ncare provider entity or organization that is licensed or certified\npursuant to article five, twenty-eight, thirty-six, forty, forty-four,\nor forty-seven of this chapter or article sixteen, nineteen, thirty-one,\nthirty-two, or thirty-six of the mental hygiene law.\n