N.Y. Comp. Codes R. & Regs. tit. 12 § 325-6.2

Current through Register Vol. 46, No. 25, June 18, 2024

Section 325-6.2 - Filing requests for reimbursement

(a) The health insurer shall be responsible for initiating claims for reimbursement of amounts paid by them which may be the responsibility of the carrier, as provided in Workers' Compensation Law section 13(d). The health insurer shall develop with the carrier its own mechanisms and standard operating procedures for payment of undisputed claims for reimbursement.

(b) Claims for reimbursement must be filed within three years of the date of payment by the health insurer for services rendered by a provider as provided in Workers' Compensation Law section 13(d). Claims for reimbursement are deemed filed with the board by submission of a request for a record search to the board in the format prescribed by the chair, pursuant to Subpart 325-5 of this Part, to identify claims which may be the responsibility of the carrier. If a health insurer receives a full match to a workers' compensation claim, the health insurer shall not be required to submit further records of treatments that are causally related to the same accident. The date of submission of the treatment that resulted in a full match shall be applicable to all subsequent treatments causally related to the same accident for purposes of the three year service requirement. HIMP-1 forms shall neither be served on nor accepted by the board. No request for reimbursement may become eligible for arbitration unless it has been timely filed and served in accordance with the provisions of this section.

N.Y. Comp. Codes R. & Regs. Tit. 12 § 325-6.2

Adopted New York State Register April 6, 2016/Volume XXXVIII, Issue 14, eff.6/1/2016