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Chapter 237 of the Laws of 2009 amendedstatutes related to claims processing and managed care

Chapter 237 of the Laws of 2009 amendedstatutes related to claims processing and managed care-2025

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The Managed Care Law of 2009 amends various statutes related to claims processing and managed care organization procedures, including credentialing, utilization review, and reimbursement arrangements. Key provisions include provisional credentialing for new providers, guidelines for adverse reimbursement changes, claims processing time frames, coordination of benefits, overpayment recovery processes, and rights regarding external appeals for denied treatments. The law aims to enhance the efficiency and fairness of managed care practices in New York.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is a PPO considered managed care?

PPOs offer in and out of network benefits. Usually the network for HMO plans is more restrictive and its managed care, so a different payment method to providers (usually capitation for HMOs, which is less reimbursement to the provider and fee for service for PPOs are higher reimbursement to providers.)

Is PPO the same as managed care?

There are three types of managed care plans: Health Maintenance Organizations (HMO) usually only pay for care within the network. You choose a primary care doctor who coordinates most of your care. Preferred Provider Organizations (PPO) usually pay more if you get care within the network.

What is Section 3224 B of the New York State Insurance Law?

(b) Overpayment to healthcare providers. (1) Other than recovery for duplicate payments, a health plan shall provide thirty days written notice to health care providers before engaging in additional overpayment recovery efforts seeking recovery of the overpayment of claims to such health care providers.

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