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New York Codes Rules Regulations (Last Updated: March 27,2024) |
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TITLE 12. Department of Labor |
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Chapter V. Workers' Compensation |
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Subchapter C. Medical Provider Authorization |
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Part 325. Medical and Surgical Care and Treatment |
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Subpart 325-6. Reimbursement for Workers' Compensation Claims Paid by Health Insurers; Arbitration of Disputed Requests for Reimbursement |
Sec. 325-6.5. Eligibility for arbitration
Latest version.
- (a) Except as provided in subdivision (b) of this section, all claims for reimbursement by a health insurer which have been timely served in accordance with the provisions of section 325-6.2 of this Subpart are eligible for and subject to mandatory arbitration to be conducted under this Subpart provided the carrier:(1) fails to make full payment or serve an objection within 90 days after the date of service of the HIMP-1 form by the health insurer on the carrier; or(2) serves an objection to reimbursement to the health insurer within 90 days after the date of service of the HIMP-1 form by the health insurer.(b) Claims for reimbursement that has not been established, either by acceptance of the claim or by board finding of ANCR, are ineligible for arbitration.