New York Public Health Law Title 2 - RIGHT TO EXTERNAL APPEAL
- 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,...
- 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...
- 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...
- 4913 - Conflict of Interest.
1. No external appeal agent or officer, director, or management employee thereof; or clinical peer reviewer employed or engaged thereby to conduct any external appeal...
- 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...
- 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...
- 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,...
- 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...
Last modified: February 3, 2019