N.Y. Comp. Codes R. & Regs. tit. 12 § 325-7.2

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

Section 325-7.2 - Insurance carrier requirements to contract with diagnostic testing networks

(a) An insurance carrier may contract with a legally and properly organized diagnostic testing network or networks as permitted by this Subpart and Workers' Compensation Law section 13-a(7) and in accordance with all applicable law.

(b) An insurance carrier that contracts with a diagnostic testing network or networks pursuant to this Subpart may require claimants to obtain or undergo diagnostic examinations and tests with an affiliated network provider.

(c) In order for an insurance carrier to require claimants to obtain or undergo diagnostic examinations and tests with an affiliated network provider, the insurance carrier, or through a designated diagnostic testing network or networks if permitted by law, must:

(1) file with the chair, or his or her designee:

(i) a list of all diagnostic testing networks it has contracted with under this section, which list shall include the name, mailing address, toll-free telephone number, email address and website address for the diagnostic testing network and the name and contact information for the manager of the diagnostic testing network or other party listed as the contact;

(ii) certification from the diagnostic testing network(s) it has contracted with that such diagnostic network has filed with the chair a list of the names and physical addresses of the medical facility or professional office location(s) where diagnostic examinations and tests will be performed and will file any changes to such list with the chair within 20 business days;

(iii) certification from the diagnostic testing network(s) it has contracted with that such diagnostic network has filed with the chair a list of the diagnostic examinations and tests offered at each medical facility or professional office location listed in subparagraph (ii) of this paragraph and will file any changes to such list with the chair within 20 business days; and

(iv) certification from the diagnostic testing network(s) it has contracted with that such diagnostic network has filed with the chair a list of the names and addresses of the licensed medical providers who may perform and/or interpret the diagnostic examinations and tests at each listed location and will file any changes to such list with the chair within 20 business days;

(2) notify the chair or his or her designee within 20 business days of the addition or removal of any diagnostic testing network or networks from the list in subparagraph (1)(i) of this subdivision; and

(3) remain compliant with all of the applicable requirements in this Subpart and Workers' Compensation Law section 13-a(7). The chair or his or her designee is authorized to request any and all information necessary to ensure such compliance and perform inspections of any affiliated network provider's facilities.

(d) The chair or his or her designee is authorized to request any and all information necessary to ensure compliance with this section from any insurance carrier that has contracted with a diagnostic testing network or networks, from any such networks, and any provider or facility that is affiliated with such networks. All insurance carriers, diagnostic testing networks, and facilities and providers affiliated with such networks must cooperate in any investigation and produce for review by the chair or his or her designee any relevant documents, including medical records, films, or other forms of test data concerning diagnostic examinations and tests performed by facilities and providers affiliated with diagnostic testing networks pursuant to this Subpart. The medical facilities and professional offices of providers affiliated with diagnostic testing networks shall be subject to inspection by the chair or his or her designee.

(e) As required by the chair, insurance carriers shall report to the chair or his or her designee specified data pertaining to utilization, quality of diagnostic examinations and tests, costs, and outcomes of the services provided by diagnostic testing networks in a prescribed format.

N.Y. Comp. Codes R. & Regs. Tit. 12 § 325-7.2