N.Y. Insurance Law Section 345
Health care claims reports


An insurer authorized to write accident and health insurance in the state, a corporation organized pursuant to article 43 (Non-profit Medical and Dental Indemnity, or Health and Hospital Service Corporations)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 § 3224-A (Standards for prompt, fair and equitable settlement of claims for health care and payments for health care services)section three thousand two hundred twenty-four-a of this chapter.

Source: Section 345 — Health care claims reports, https://www.­nysenate.­gov/legislation/laws/ISC/345 (updated Apr. 17, 2020; accessed Oct. 26, 2024).

301
Regulations by superintendent
302
Supervisory colleges
306
Immunity from prosecution
307
Annual statements
308
Special reports
309
Examinations of insurers
310
Examinations
311
Filing of report on examination
312
Report on examination to be forwarded
314
Public retirement and pension systems
315
Professional malpractice or misconduct
316
Electronic filings
317
Compliance with reporting requirements of the financial security act
318
Reports of fire losses
319
Release of information resulting from insurers’ investigation of fires
320
Records to be made available by organizations subject to the provisions of this chapter
321
Medical information exchange centers
322
Prohibited referral payment to licensees by motor vehicle repairers
325
Records of domestic insurers
329
Certificates as evidence
330
Rating services available to other states
331
Superintendent to maintain index of tax districts
333
Assessments to defray expenses of Committee on Valuation of Securities of the National Association of Insurance Commissioners
335
Implementation of hospital reimbursement methodology
336
War risk exclusion
337
Annual consumer guide on automobile insurance
339
Colorectal cancer screening notification
340
Report of claims that may result in a monetary award
341
Notification regarding qualified health insurance plans
342
Public awareness to finance long term care
343
Mental health and substance use disorder parity report
344
Mental health and substance use disorder parity compliance programs
345
Health care claims reports

Accessed:
Oct. 26, 2024

Last modified:
Apr. 17, 2020

§ 345’s source at nysenate​.gov

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