New York Public Health - Title 2 - (4910 - 4917) Right to External Appeal
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- New York Public Health - § Title 2 - Right to External Appeal
established. 4911. Powers of the commissioner. 4912. Standards for certification. 4913. Conflict of interest. 4914. Procedures for external appeals of adverse determinations. 4915. Prohibited practices....
- New York Public Health - § 4910 - Right to External Appeal Established
1. There is hereby established an enrollee's right to an external appeal of a final adverse determination by a health care plan. 2. An enrollee,...
- New York Public Health - § 4911 - Powers of the Commissioner
1. The commissioner shall have the power to grant and revoke certifications of external appeal agents to conduct external appeals requested pursuant to either paragraph...
- New York Public Health - § 4912 - Standards for Certification
1. The commissioner shall develop an application for certification. At a minimum, applicants shall provide: (a) a description of the qualifications of the clinical peer...
- New York Public Health - § 4913 - Conflict of Interest
where such conflict may be unavoidable.
- New York Public Health - § 4914 - Procedures for External Appeals of Adverse Determinations
1. The commissioner shall establish procedures by regulation to randomly assign an external appeal agent to conduct an external appeal, provided that the commissioner may...
- New York Public Health - § 4915 - Prohibited Practices
An external appeal agent shall not, with respect to external appeal activities, permit or provide compensation or anything of value to its employees, agents, or...
- New York Public Health - § 4916 - Oversight and Surveillance of the External Appeal Process
1. The commissioner shall have the power to: (a) review the activities of the health care plans and external appeal agents pursuant to this title,...
- New York Public Health - § 4917 - Hold Harmless
A health care provider requesting an external appeal of a concurrent adverse determination, including when the health care provider requests an external appeal as the...