(a) either a percentage of the amount by which a claim is reduced for
payment or the number of claims or the cost of services for which the
person has denied authorization or payment; or
(b) any other method that encourages the upholding of an adverse
determination.
Structure New York Laws
Article 49 - Utilization Review and External Appeal
Title 2 - Right to External Appeal
4910 - Right to External Appeal Established.
4911 - Powers of the Superintendent.
4912 - Standards for Certification.
4914 - Procedures for External Appeals of Adverse Determinations.
4916 - Oversight and Surveillance of the External Appeal Process.