N.Y. Public Health Law Section 4915
Prohibited practices

An external appeal agent shall not, with respect to external appeal activities, permit or provide compensation or anything of value to its employees, agents, or contractors based on:

1.

either a percentage of the amount by which a claim is reduced for payment or the number of claims or the cost of services for which the person has denied authorization or payment; or

2.

any other method that encourages the upholding of an adverse determination.

Source: Section 4915 — Prohibited practices, https://www.­nysenate.­gov/legislation/laws/PBH/4915 (updated Sep. 22, 2014; accessed Oct. 26, 2024).

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Accessed:
Oct. 26, 2024

Last modified:
Sep. 22, 2014

§ 4915’s source at nysenate​.gov

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