N.Y. Comp. Codes R. & Regs. tit. 12 § 444.3

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

Section 444.3 - Payment of bills and reimbursement requests

(a) Bills submitted by a dental provider to the carrier or self-insured employer for payment or reimbursement shall be paid according to the fee schedule adopted under Workers' Compensation Law, section 13(a) within 45 calendar days of receipt of the bill or reimbursement request.

(b) Where the liability of the self-insured employer or carrier for the claim has not been established or the treatment or procedure is not for a causally related condition, the self-insured employer or carrier shall pay any undisputed amount of the bill or reimbursement request and notify the board, claimant and dental provider in writing using the form prescribed by the chair for this purpose within 45 calendar days of receipt of the claim or reimbursement request:

(1) that the claim is not being paid and the reason for non-payment of the claim; or

(2) to request additional information needed to reasonably determine the self-insured employer's or carrier's liability for the claim or whether the dental treatment or procedure is causally related to the injury.

Upon receipt of the information reasonably requested, the self-insured employer or carrier shall have 30 days to pay the bill or reimbursement request or provide written notice to the board, claimant and dental provider using the form prescribed by the chair for this purpose explaining why the bill is not being paid with copies of the additional information requested attached to the form to support the determination.

(c) Where the self-insured employer or carrier has failed to pay a bill or reimbursement request or make a reasonable request for additional information within 45 calendar days, the self-insured employer or carrier is deemed to have waived any objection to liability for the bill or reimbursement request and shall pay the bill or reimbursement request.

N.Y. Comp. Codes R. & Regs. Tit. 12 § 444.3