Authorizes the imposition of penalties on subcontractors for failure to adhere to the standards for prompt, fair and equitable settlement of claims for health care and payments for health care services.
Impact
If enacted, A09265 would alter the existing framework of health insurance claims processing in New York. By empowering the superintendent to levy penalties on subcontractors, the bill aims to ensure that these entities also adhere to the established claims settlement standards. This change could potentially lead to more timely processing of claims and foster improved relationships between health care providers and insurance companies. It signals a move towards more stringent regulations to protect healthcare providers from unfair practices.
Summary
Assembly Bill A09265 aims to enhance the accountability of health care insurance companies and their subcontractors regarding the settlement of claims for health care services. The bill specifically allows the superintendent to impose penalties on subcontractors who fail to adhere to the standards for prompt, fair, and equitable settlements of claims. This is significant as it adds an additional layer of scrutiny on subcontractors, who are often involved in the claims process but have previously operated with minimal oversight when it comes to compliance with these standards.
Contention
Notable points of contention surrounding the bill include concerns from some stakeholders about increased regulatory burdens on subcontractors. Critics argue that while the intention to ensure compliance is positive, the implementation of additional penalties may lead to complications and slowdowns in the claims process as subcontractors grapple with the added accountability. Proponents, however, assert that the benefits of ensuring that all parties involved in claims processing adhere to fair practices outweigh these concerns.
Same As
Authorizes the imposition of penalties on subcontractors for failure to adhere to the standards for prompt, fair and equitable settlement of claims for health care and payments for health care services.
Authorizes the imposition of penalties on subcontractors for failure to adhere to the standards for prompt, fair and equitable settlement of claims for health care and payments for health care services.
Prohibits contractors from submitting claims and receiving payment from subcontractors who are not pre-authorized by a contracting city agency; establishes penalties.
To Prohibit Healthcare Insurers From Exercising Recoupment For Payment Of Healthcare Services More Than One Year After The Payment For Healthcare Services Was Made.
Relates to the definition of "reproductive health services" for purposes of the offense of criminal interference with health care services or religious worship in the second degree; defines "legally protected health activity"; increases the penalties for the criminal interference with health care services or religious worship in the first and second degrees, and for aggravated interference with health care services in the second degree.
Relates to the definition of "reproductive health services" for purposes of the offense of criminal interference with health care services or religious worship in the second degree; defines "legally protected health activity"; increases the penalties for the criminal interference with health care services or religious worship in the first and second degrees, and for aggravated interference with health care services in the second degree.
Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.
Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.
Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.