New York guidance: Insurers can't deny hospital claims for administrative reasons

Morgan Haefner - Print  | 

A new guidance from the New York Department of Financial Services prohibits health insurers from denying hospital claims for administrative reasons.

The guidance, outlined in a March 10 circular letter, prohibits health insurers from denying payment to hospitals for medically necessary inpatient hospital services, observation services and emergency department services, along with emergency admissions, for purely administrative reasons. Likewise, the guidance prohibits health insurers from denying payment by contract, written policy or procedure for those services based on the fact that certain administrative requirements weren't met.

Additionally, insurers must make a decision on preauthorization requests for inpatient rehabilitation services following an admission within one business day, as well as use national coding guidelines when reviewing claims.

Read the full letter here.

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