N.Y. Insurance Law § 4806: Health care facility applications

§ 4806. Health care facility applications. (a) An insurer that offers

a managed care product shall, upon request, make available and disclose

to facilities written application procedures and minimum qualification

requirements that a facility must meet in order to be considered by the

insurer for participation in the in-network benefits portion of the

insurer's network for the managed care product. The insurer shall

consult with appropriately qualified facilities in developing its

qualification requirements for participation in the in-network benefits

portion of the insurer's network for the managed care product. An

insurer shall complete review of the facility's application to

participate in the in-network portion of the insurer's network and,

within sixty days of receiving a facility's completed application to

participate in the insurer's network, shall notify the facility as to:

(1) whether the facility is credentialed; or (2) whether additional time

is necessary to make a determination because of a failure of a third

party to provide necessary documentation. In such instances where

additional time is necessary because of a lack of necessary

documentation, an insurer shall make every effort to obtain such

information as soon as possible and shall make a final determination

within twenty-one days of receiving the necessary documentation.

(b) For the purposes of this section, "facility" shall mean a health

care provider that is licensed or certified pursuant to article five,

twenty-eight, thirty-six, forty, forty-four, or forty-seven of the

public health law or article sixteen, nineteen, thirty-one, thirty-two,

or thirty-six of the mental hygiene law.