New York § 4915 Prohibited practices

New York Statutes

§ 4915 — Prohibited practices

New York·Law PBH Public Health·Title 2 Right to External Appeal·Art. 49 Utilization Review and External Appeal

  § 4915. Prohibited practices. An external appeal agent shall not, with\nrespect to external appeal activities, permit or provide compensation or\nanything of value to its employees, agents, or contractors based on:\n  1. either a percentage of the amount by which a claim is reduced for\npayment or the number of claims or the cost of services for which the\nperson has denied authorization or payment; or\n  2. any other method that encourages the upholding of an adverse\ndetermination.\n

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§ 4915. Prohibited practices. An external appeal agent shall not, with\nrespect to external appeal activities, permit or provide compensation or\nanything of value to its employees, agents, or contractors based on:\n 1. either a percentage of the amount by which a claim is reduced for\npayment or the number of claims or the cost of services for which the\nperson has denied authorization or payment; or\n 2. any other method that encourages the upholding of an adverse\ndetermination.\n

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