New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.3 - Notice of carrier's objections to bills and hospital's request for arbitration

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) A carrier objecting to any bill for
				  hospital care or for services performed by a hospital shall notify the hospital
				  in writing that the bill is not being paid and explain the reasons for
				  nonpayment within 45 days after the bill has been submitted in accordance with
				  section
				  325-1.24
				  or
				  325-1.25 
				  of this Title. The notification shall contain the name, telephone number,
				  facsimile transmission number and email address, if available, of a contact
				  person to whom the hospital may address any inquiry regarding the carrier's
				  objection to the bill. The carrier shall set forth the specific basis for its
				  nonpayment of the bill and explain in detail the reasons supporting its
				  objections. Any objection which sets forth the specific basis for nonpayment
				  but does not explain in detail the reasons supporting the objection shall not
				  be considered sufficient notification in writing for purposes of this
				  section.
(2) Notwithstanding the
				  provisions of paragraph (1) of this subdivision, in any case the submission of
				  a notice of controversy and notice of treatment issue or bill dispute in the
				  format prescribed by the chair and service of the notice upon the hospital
				  within such 45-day period shall be deemed to be a notification in writing
				  explaining the reasons for nonpayment with respect to any legal objections
				  raised therein. In lieu of providing such notices to the hospital, the carrier
				  may send the hospital a sufficiently detailed written explanation raising legal
				  objections to the bill. If the carrier has timely submitted such notices with
				  the chair and served a copy of the notice upon the hospital or sent the
				  hospital a sufficiently detailed written explanation raising legal objections
				  to the bill, the carrier shall notify the hospital in writing that the bill is
				  not being paid and explain the reasons for nonpayment, in the same manner as
				  set forth in paragraph (1) of this subdivision, within 30 days after all
				  questions duly and timely raised with respect to the carrier's liability for
				  such bill have been finally determined adversely to the carrier; provided,
				  however, that the explanation for nonpayment shall not be on the basis of any
				  issues previously adjudicated by the Workers' Compensation Law judge or the
				  board which have been finally determined adversely to the carrier. If the
				  carrier files an application for review of a decision by a Workers'
				  Compensation Law judge, the carrier shall serve a copy of the application for
				  review, together with the prescribed cover sheet (form RB-89) on the hospital
				  simultaneously with its service on all other parties required to be served. The
				  carrier may notify the hospital in writing that it has filed an application for
				  review, in lieu of serving a copy of the application and cover sheet on the
				  hospital.
(3) If the carrier fails
				  to object to a bill in accordance with the provisions of section
				  325-1.24
				  or
				  325-1.25 
				  of this Title and this subdivision, the hospital may request an administrative
				  award in accordance with section
				  325-1.24
				  or
				  325-1.25 
				  of this Title.