N.Y. Comp. Codes R. & Regs. tit. 11 § 17.0
Current through Register Vol. 46, No. 25, June 18, 2024
(a) Chapter 545 of the Laws of 1977 provides, as a means to simplify and reduce the cost of processing health insurance claims, for the establishment of standard claim forms for the services of hospitals, physicians and other health care providers to be used for all claims arising out of accident and health insurance written by commercial insurance companies. The establishment of the standard claim forms in this Part should expedite the settlement of claims and result in cost savings which can be passed on to those purchasing health insurance benefits.(b) The Superintendent of Insurance is to establish standard claim forms after investigation and review of claim forms currently being utilized by commercial insurance companies and health care providers. To assist and advise the superintendent in his investigation and review of claim forms in use, and to provide expert opinion on the content of standard claim forms, the superintendent appointed an Advisory Committee on Standard Claim Forms for Accident and Health Insurance, consisting of representatives from the Hospital Association of New York State, New York State Medical Society, New York State Dental Society, the Office of Health Systems Management, Consumer Protection Board, Health Insurance Association of America and the insurance industry. During the course of the superintendent's investigation, it was revealed with regard to hospital claims, that the great volume of claims processed by hospitals relate to persons covered by Medicaid, Medicare and Blue Cross, with a relatively small percentage of hospital bills paid by commercial insurance companies. Commercial insurance companies are the only payors affected by chapter 545 of the Laws of 1977 and this Part.(c) In an effort to develop a model data system in New York State for the purposes of health care planning and financing, the Health Care Financing Administration of the United States Department of Health, Education and Welfare awarded a grant in 1977 to the New York State Office of Health Systems Management to establish, among other things, a uniform inpatient hospital billing form. The Superintendent of Insurance was represented on the Uniform Billing Advisory Committee which assisted the Office of Health Systems Management Project Staff in the development of a uniform inpatient hospital billing form, which is a single claim form for use by Medicaid, Medicare, Blue Cross and commercial insurance companies.(d) The uniform inpatient hospital billing form (UBF-1) developed by the Office of Health Systems Management is currently being tested in selected hospitals in the New York City area for the Medicaid patients and statewide implementation of the form for use in all hospitals is scheduled by the Office of Health Systems Management to begin July 1, 1979 and to be completed November 1, 1979.(e) Representatives of the Hospital Association of New York State; the Greater New York Hospital Association; New York State Departments of Social Services, Health and Insurance; Federal government agencies; Blue Cross; and commercial insurers as well as other interested parties participated in the development of the UBF-1 form and are currently cooperating in efforts to test and/or implement the use of the uniform inpatient hospital billing form within the time period proposed by the Office of Health Systems Management.(f) Recognizing the significance and scope of the project undertaken by the Office of Health Systems Management, as well as the duplicative purpose of their efforts and the intent of chapter 545 of the Laws of 1977 as it relates to a hospital claim form, the most sensible and practical position at this time is to establish as the standard hospital claim form the uniform inpatient hospital billing form adopted by the Office of Health Systems Management, which form is intended for use by hospitals and payors beginning July 1, 1979.(g) Chapter II of the Laws of 1981 requires that article IX-C corporations use standard claim forms established by the superintendent. The superintendent requested comments from the New York State Medical Society, the New York State Dental Society and other interested parties and conducted meetings with representatives of commercial insurers and article IX-C corporations in order to determine appropriate standard claim forms for use by both commercial insurers and article IX-C corporations.(h) As part of an ongoing review of the uniform inpatient hospital billing form by the Office of Health Systems Management, commercial insurers and article IX-C corporations participated in the updating of the UBF-1 form. Accordingly, adoption of the updated UBF-1-81 as the standard hospital claim form for commercial insurers and article IX-C corporations is appropriate.(i) Under the leadership of the Health Care Financing Administration of the United States Department of Health and Human Services, representatives of the New York State Department of Social Services, the New York State Department of Insurance, other Federal government agencies, commercial insurers and article IX-C corporations, and other interested parties participated in the establishment of a New York State version of a federally developed physician claim form designed to serve as a single claim form for use by Medicare, Medicaid, commercial insurance companies and article IX-C corporations.(j) Recognizing that the New York State version of the federally developed physician claim form would serve the very purpose of chapter 545 of the Laws of 1977 and chapter 11 of the Laws of 1981, and in order to avoid the use of multiple standard claim forms, the most appropriate standard claim form for the services of physicians to be used by commercial insurers and article IX-C corporations is the New York State version of the federally developed form. The establishment of such a form will result in one common standard claim form to be used by the most significant third-party payors in New York State.(k) The existing standard claim form for the services of dentists was found to fulfill the needs of commercial insurers and article IX-C corporations and, therefore, will continue to be the established standard claim form.N.Y. Comp. Codes R. & Regs. Tit. 11 § 17.0