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New York Updates Health Claim And Network Laws

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Empire State lawmakers have imposed new requirements on health insurers and health maintenance organizations’ efforts to process claims and run provider networks.

One new section of the New York state insurance laws will require health carriers to accept any physician claims submitted using the Current Procedural Terminology codes developed by the American Medical Association, Chicago, and the Health Care Common Procedure Coding System used by the Centers for Medicare and Medicaid Services, according to Circular Letter Number 23 (2006).

The universal coding requirement will take effect for claims that health carriers receive after Jan. 1, 2007, Lisette Johnson, a department health bureau official, writes in the circular letter.

Every New York health carrier also must “indicate on its provider Web site and in provider newsletters the name of the commercially available software product, including any significant edits, used by the plan to accept/edit claims,” Johnson writes.

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Unless a health carrier is trying to recover duplicate payments, it must provide written notice to a physician 30 days before engaging in any collection of overpayments, Johnson writes.

Another new health insurance law requires health carriers to respond within 90 days to providers who file applications requesting admission to the carriers’ provider networks, Johnson writes.

A copy of the circular letter is on the Web at Document Link