§ 345. Health care claims reports. An insurer authorized to write
accident and health insurance in the state, a corporation organized
pursuant to article forty-three of this chapter, or a health maintenance
organization certified pursuant to article forty-four of the public
health law shall report to the superintendent quarterly and annually on
health care claims payment performance with respect to comprehensive
health insurance coverage. The reports shall be submitted in the manner
and form prescribed by the superintendent after consultation with
representatives of insurers and health care providers but at minimum
shall include the number and dollar value of health care claims by major
line of business and categorized as follows: health care claims
received, health care claims paid, health care claims pended and health
care claims denied during the respective quarter or year. The data shall
be provided in the aggregate and by major category of health care
provider. The reports should address any patterns or suspected areas of
revenue maximization that may have contributed to the number of denials.
The reports shall be due to the superintendent no later than forty-five
days after the end of the respective quarter or year and shall be made
publicly available including on the department's website. The
superintendent, in conjunction with the commissioner of health, may
promulgate regulations requiring additional reporting requirements on
insurers, corporations, or health maintenance organizations or health
care providers to assess the effectiveness of the payment policies set
forth in this section, which may be informed by the administrative
simplification workgroup authorized by subsection (k) of section three
thousand two hundred twenty-four-a of this chapter.