N.Y. Comp. Codes R. & Regs. tit. 10 § 350.2

Current through Register Vol. 46, No. 50, December 11, 2024

Section 350.2 - APD data submission

(a) Third-party health care payers shall submit complete, accurate, and timely APD data to the Department, pursuant to the submission specifications.

(b) The Department shall consult with the Department of Financial Services and third-party health care payers before issuing any submission specifications.

(c) The Department shall set a compliance date of at least 120 days from the date that new or revised submission specifications are issued.

(d) Third-party health care payers shall submit APD data in a n electronic, computer-readable format through a secure electronic network of the Department or its designated administrator on a monthly basis, or more frequently, as specified in the submission specifications.

(e) Third-party health care payers shall submit at least 95 percent of APD data within 60 days from the end of the month that the adjudicated claims were paid.

(f) Third-party health care payers shall submit 100 percent of APD data within 180 days from the end of the month of the adjudicated claims being submitted for payment.

(g) The Department may audit APD data submitted by third-party health care payers to evaluate the quality, timeliness, and completeness of the data. The Department may issue an audit report or statement of deficiencies listing any inadequacies or inconsistencies in the APD data submitted and requiring corrective actions. Any third-party health care payer that receives an audit report or statement of deficiencies shall submit a plan of correction to the Department within 30 days from the date of receipt of the audit report or statement of deficiencies. Third-party heath care payers shall be in full compliance with APD data submission specifications and the plan of correction within 90 days from the date of submission of the plan of correction.

(h) A third-party health care payer may submit a written request to the Department for an extension, variance, or waiver of APD data submission specifications requirements. The written request shall include: the specific requirement to be extended, varied, or waived; an explanation of the reason or cause; the methodology proposed to eliminate the need for future extension, variance, or waiver; and the time frame required to come into compliance. The Department shall respond to such requests as soon as practicable.

(i) Any third-party health care payer that violates this section shall be liable pursuant to the provisions of the Public Health Law, including, but not limited to, sections 12 and 12-d of the Public Health Law, and applicable sections of New York State Insurance Law and regulations.

N.Y. Comp. Codes R. & Regs. Tit. 10 § 350.2

Adopted New York State Register September 13, 2017/Volume XXXIX, Issue 37, eff. 9/13/2017