N.Y. Insurance Law § 345: Health care claims reports

§ 345. Health care claims reports. An insurer authorized to write

accident and health insurance in the state, a corporation organized

pursuant to 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 section three

thousand two hundred twenty-four-a of this chapter.