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 Jan. 18, 2025).

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
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Accessed:
Jan. 18, 2025

Last modified:
Apr. 17, 2020

§ 345’s source at nysenate​.gov

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