ALBANY — New York State on March 15 issued guidance alerting insurers of new protections for patients and health-care providers that “limit” health-insurance claims denials and “inappropriate” payment reductions or delays related to “medically necessary” services. The state says the actions are needed to speed up access to health-care services as the COVID-19 pandemic continues. […]
ALBANY — New York State on March 15 issued guidance alerting insurers of new protections for patients and health-care providers that “limit” health-insurance claims denials and “inappropriate” payment reductions or delays related to “medically necessary” services.
The state says the actions are needed to speed up access to health-care services as the COVID-19 pandemic continues.
The protections were outlined in a letter from the New York State Department of Financial Services (DFS). They were also included in the enacted 2021 budget and became effective on Jan. 1, Cuomo’s office said.
They prohibit insurers from denying hospital claims for administrative reasons, require insurers to use national coding guidelines when reviewing hospital claims, and shorten timeframes for insurers to make medical-necessity determinations.
“DFS will continue to remove roadblocks to New Yorkers receiving the health care they deserve,” Linda Lacewell, superintendent of financial services said in a release. “DFS commends the insurance industry for its collaboration on [this] guidance.”
The letter advises insurers of several new requirements, including that insurers must not deny a payment for medically necessary services based on a hospital’s noncompliance with an insurer’s administrative requirements, per Cuomo’s office.
Insurers must also decide on a preauthorization request for inpatient-rehabilitation services following an inpatient hospital admission within one business day from the receipt of “necessary information.”
Insurers must pay claims — submitted through the internet or electronically — within 30 days of receipt when the insurer’s obligation to pay the claim is “reasonably clear” and, if additional information is needed, payment must be made within 15 days of a determination that payment is due.
