New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 17 - Standard Health Insurance Claims Forms For The Services Of Physicians, Dentists And Hospitals › Section 17.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Chapter 545 of
				the Laws of 1977 provides, as a means to simplify and reduce the cost of
				processing health insurance claims, for the establishment of standard claim
				forms for the services of hospitals, physicians and other health care providers
				to be used for all claims arising out of accident and health insurance written
				by commercial insurance companies. The establishment of the standard claim
				forms in this Part should expedite the settlement of claims and result in cost
				savings which can be passed on to those purchasing health insurance
				benefits.
(b) The Superintendent of
				Insurance is to establish standard claim forms after investigation and review
				of claim forms currently being utilized by commercial insurance companies and
				health care providers. To assist and advise the superintendent in his
				investigation and review of claim forms in use, and to provide expert opinion
				on the content of standard claim forms, the superintendent appointed an
				Advisory Committee on Standard Claim Forms for Accident and Health Insurance,
				consisting of representatives from the Hospital Association of New York State,
				New York State Medical Society, New York State Dental Society, the Office of
				Health Systems Management, Consumer Protection Board, Health Insurance
				Association of America and the insurance industry. During the course of the
				superintendent's investigation, it was revealed with regard to hospital claims,
				that the great volume of claims processed by hospitals relate to persons
				covered by Medicaid, Medicare and Blue Cross, with a relatively small
				percentage of hospital bills paid by commercial insurance companies. Commercial
				insurance companies are the only payors affected by chapter 545 of the Laws of
				1977 and this Part.
(c) In an
				effort to develop a model data system in New York State for the purposes of
				health care planning and financing, the Health Care Financing Administration of
				the United States Department of Health, Education and Welfare awarded a grant
				in 1977 to the New York State Office of Health Systems Management to establish,
				among other things, a uniform inpatient hospital billing form. The
				Superintendent of Insurance was represented on the Uniform Billing Advisory
				Committee which assisted the Office of Health Systems Management Project Staff
				in the development of a uniform inpatient hospital billing form, which is a
				single claim form for use by Medicaid, Medicare, Blue Cross and commercial
				insurance companies.
(d) The
				uniform inpatient hospital billing form (UBF-1) developed by the Office of
				Health Systems Management is currently being tested in selected hospitals in
				the New York City area for the Medicaid patients and statewide implementation
				of the form for use in all hospitals is scheduled by the Office of Health
				Systems Management to begin July 1, 1979 and to be completed November 1,
				1979.
(e) Representatives of the
				Hospital Association of New York State; the Greater New York Hospital
				Association; New York State Departments of Social Services, Health and
				Insurance; Federal government agencies; Blue Cross; and commercial insurers as
				well as other interested parties participated in the development of the UBF-1
				form and are currently cooperating in efforts to test and/or implement the use
				of the uniform inpatient hospital billing form within the time period proposed
				by the Office of Health Systems Management.
(f) Recognizing the significance and scope of
				the project undertaken by the Office of Health Systems Management, as well as
				the duplicative purpose of their efforts and the intent of chapter 545 of the
				Laws of 1977 as it relates to a hospital claim form, the most sensible and
				practical position at this time is to establish as the standard hospital claim
				form the uniform inpatient hospital billing form adopted by the Office of
				Health Systems Management, which form is intended for use by hospitals and
				payors beginning July 1, 1979.
(g)
				Chapter II of the Laws of 1981 requires that article IX-C corporations use
				standard claim forms established by the superintendent. The superintendent
				requested comments from the New York State Medical Society, the New York State
				Dental Society and other interested parties and conducted meetings with
				representatives of commercial insurers and article IX-C corporations in order
				to determine appropriate standard claim forms for use by both commercial
				insurers and article IX-C corporations.
(h) As part of an ongoing review of the
				uniform inpatient hospital billing form by the Office of Health Systems
				Management, commercial insurers and article IX-C corporations participated in
				the updating of the UBF-1 form. Accordingly, adoption of the updated UBF-1-81
				as the standard hospital claim form for commercial insurers and article IX-C
				corporations is appropriate.
(i)
				Under the leadership of the Health Care Financing Administration of the United
				States Department of Health and Human Services, representatives of the New York
				State Department of Social Services, the New York State Department of
				Insurance, other Federal government agencies, commercial insurers and article
				IX-C corporations, and other interested parties participated in the
				establishment of a New York State version of a federally developed physician
				claim form designed to serve as a single claim form for use by Medicare,
				Medicaid, commercial insurance companies and article IX-C
				corporations.
(j) Recognizing that
				the New York State version of the federally developed physician claim form
				would serve the very purpose of chapter 545 of the Laws of 1977 and chapter 11
				of the Laws of 1981, and in order to avoid the use of multiple standard claim
				forms, the most appropriate standard claim form for the services of physicians
				to be used by commercial insurers and article IX-C corporations is the New York
				State version of the federally developed form. The establishment of such a form
				will result in one common standard claim form to be used by the most
				significant third-party payors in New York State.
(k) The existing standard claim form for the
				services of dentists was found to fulfill the needs of commercial insurers and
				article IX-C corporations and, therefore, will continue to be the established
				standard claim form.