New York: Guidance for Payment of Health Insurance Claims

New York: Guidance for Payment of Health Insurance Claims

Governor Cuomo Announces New Guidance from the Department of Financial Services for the Fair and Prompt Payment of Health Insurance Claims

New York (STL.News) Governor Andrew M. Cuomo today announced the issuance of new guidance by the Department of Financial Services alerting insurers of new protections for patients and healthcare providers that limit health insurance claims denials and inappropriate payment reductions or delays related to medically necessary services.

“Claim denials and payment delays for administrative reasons are the last things New Yorkers need in the middle of a public health crisis,” Governor Cuomo said.  “This action speeds up access to healthcare for all New Yorkers and gives them some measure of peace as we continue to build back from the pandemic.”

These protections outlined in the circular letter, which were included in the Governor’s enacted 2021 budget and became effective on January 1, 2021, prohibit insurers from denying hospital claims for administrative reasons, require insurers to use national coding guidelines when reviewing hospital claims, and shorten timeframes for insurers to make medical necessity determinations.

Superintendent of Financial Services Linda A. Lacewell said, “DFS will continue to remove roadblocks to New Yorkers receiving the healthcare they deserve. 

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Author: Publisher3