|Assembly Actions - Lowercase
Senate Actions - UPPERCASE
|Jan 04, 2012||referred to insurance|
|Jan 05, 2011||referred to insurance|
senate Bill S160
Archive: Last Bill Status -
- In Committee
- On Floor Calendar
- Passed Senate
- Passed Assembly
- Delivered to Governor
- Signed/Vetoed by Governor
S160 - Details
- Law Section:
- Insurance Law
- Laws Affected:
- Amd §§3224-a, 4803 & 3217-b, Ins L; amd §§4406-c & 4406-d, Pub Health L
- Versions Introduced in 2009-2010 Legislative Session:
S160 - Sponsor Memo
BILL NUMBER:S160 TITLE OF BILL: An act to amend the insurance law and the public health law, in relation to establishing procedures for the collection of overpayments from health care providers based upon eligibility of the insured; and requiring insurers to notify health care professionals by written and electronic formats regarding particular billing codes; and requiring contracts entered into with a health care provider to include certain information PURPOSE: Would assure that Physicians and other health care providers are given adequate information when health plans seek refunds for previous payments, and would assure that physicians are given information up front about those items which might subject them to a health plan audit in the future. SUMMARY OF PROVISIONS: The legislation would amend Section 3224-a of the Insurance Law to establish procedures for the collection of overpayments based upon eligibility of the insurer, and when the plan believes they overpaid the provider. 1. For refund demands based on eligibility, the legislation would require health insurance companies and HMOs to give specific
S160 - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 160 2011-2012 Regular Sessions I N S E N A T E (PREFILED) January 5, 2011 ___________ Introduced by Sen. MAZIARZ -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law and the public health law, in relation to establishing procedures for the collection of overpayments from health care providers based upon eligibility of the insured; and requiring insurers to notify health care professionals by written and electronic formats regarding particular billing codes; and requiring contracts entered into with a health care provider to include certain information THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 3224-a of the insurance law is amended by adding a new subsection (b-1) to read as follows: (B-1) WHERE AN INSURER OR ORGANIZATION OR CORPORATION SEEKS A REFUND FROM A HEALTH CARE PROVIDER OF A PAYMENT PREVIOUSLY MADE FOR HEALTH CARE SERVICES: (1) IN A CASE WHERE AN INSURER OR ORGANIZATION OR CORPORATION IS SEEK- ING A REFUND FOR PAYMENT PREVIOUSLY MADE BASED UPON A GOOD FAITH BELIEF REGARDING THE ELIGIBILITY OF A PERSON FOR COVERAGE, OR THE LIABILITY OF ANOTHER INSURER OR CORPORATION OR ORGANIZATION FOR ALL OR PART OF THE CLAIM, THE INSURER OR ORGANIZATION OR CORPORATION MUST NOTIFY THE HEALTH CARE PROVIDER IN WRITING THE AMOUNT OF THE REFUND BEING SOUGHT, THE SPECIFIC REASONS WHY THE REFUND IS BEING SOUGHT, AND ANY INFORMATION IT MAY HAVE REGARDING ANOTHER INSURER, ORGANIZATION, CORPORATION OR OTHER ENTITY THAT MAY BE LEGALLY OBLIGATED TO MAKE PAYMENT. IF THE INSURER, ORGANIZATION OR CORPORATION SEEKING THE REFUND DOES NOT MAINTAIN ANY SUCH INFORMATION, IT SHALL SO STATE ON THE NOTICE TO THE HEALTH CARE PROVIDER. NOTICE OF SUCH REFUND DEMAND SHALL BE MADE AS SOON AS REASON- ABLY PRACTICABLE AFTER RECEIPT OF INFORMATION THAT SUCH INSURER, ORGAN- IZATION OR CORPORATION WAS NOT RESPONSIBLE FOR PAYMENT. FAILURE TO IDEN- EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
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