N.Y. Comp. Codes R. & Regs. tit. 12 § 327.2

Current through Register Vol. 46, No. 45, November 2, 2024

Section 327.2 - Notice of carrier's objection to bill and hospital's request for arbitration of bills for services rendered prior to october 1, 1994

(a) Notice of objection by a carrier to any bill for hospital care (herein referred to as a hospital bill) or for services performed by a hospital shall be given to the chair in duplicate and two copies to the hospital whose bill is in dispute within 30 days after such bill has been rendered, notice of objection to be in the form (A-1) prescribed by the chair for that purpose. The notice shall briefly state all of the carrier's objections to the bill. Where compensability of the claim is controverted and has not yet been determined, or where other issues requiring Workers' Compensation Board determination are interposed as reasons for nonpayment of the bill, the notice of objection shall so state.

(b) Upon receipt of such notice of objection (A-1), the hospital may request arbitration by notifying the chair in accordance with the following:

(1) if only arbitration issues are raised, the request for arbitration shall be made within 60 days after receipt of the notice of objection (A-1);

(2) if there are issues requiring adjudication by a Workers' Compensation Law judge in addition to arbitration issues, the request for arbitration shall be made within 60 days of the filing of the decision in favor of the hospital; and

(3) failure to make timely request for arbitration shall be deemed a waiver of the right to arbitration.

If the hospital wishes to arbitrate the bill, it shall complete and sign the request form for arbitration and forward it to the medical registration section together with a check to the order of the Chair, Workers' Compensation Board, in the sum of $5 as a minimum arbitration fee. Notwithstanding any provision in this section to the contrary, upon application of the hospital, the chair may for good cause shown excuse the hospital for the delay in filing the request for arbitration, and schedule the disputed bill for arbitration.

(c) Failure of the hospital to render a bill to the carrier within 120 days from the last day of the month in which services were rendered shall be deemed to be a waiver of the right to arbitrate the bill. Notwithstanding any provision in this section to the contrary, upon application of the hospital, the chair may for good cause shown excuse the hospital for the delay in submitting such bill to the carrier, and schedule the disputed bill for arbitration.

(d) Notwithstanding any provisions of this section to the contrary, arbitration of hospital bills for services performed on or after October 1, 1994 shall be subject to the provisions of section 327.3 of this Part.

(e) The provisions of this Part shall apply to arbitration of outpatient hospital bills only. Bills for inpatient hospital services for any patient discharged on or after January 1, 1991 are subject to arbitration pursuant to the Public Health Law and regulations promulgated thereunder.

N.Y. Comp. Codes R. & Regs. Tit. 12 § 327.2