New York Laws
ISC - Insurance
Article 49 - Utilization Review and External Appeal

Title 1 - Registration of Agents and Review Process

4900 - Definitions. - (a) "Adverse determination" means a determination by a utilization review...

4901 - Reporting Requirements for Utilization Review Agents. - (b) Such report shall contain a description of the following:...

4902 - Utilization Review Program Standards. - (1) Appointment of a medical director, who is a licensed...

4903 - Utilization Review Determinations. - (1) Administrative personnel trained in the principles and procedures of...

4903-A - Utilization Review Determinations for Medically Fragile Children. - (b) In the case of a medically fragile child, the...

4904 - Appeal of Adverse Determinations by Utilization Review Agents. - (a-1) An insured or the insured's designee may appeal an...

4905 - Required and Prohibited Practices. - (1) kept confidential in accordance with applicable state and federal...

4906 - Waiver. - (b) Notwithstanding subsection (a) of this section, in lieu of...

4907 - Rights and Remedies. - § 4907. Rights and remedies. The rights and remedies conferred...

4908 - Applicability to Erisa Plans. - § 4908. Applicability to ERISA Plans. Notwithstanding the foregoing, the...

4909 - Site of Service Clinical Review. - (1) "Free-standing ambulatory surgical center" shall mean a diagnostic and...

Title 2 - Right to External Appeal

4910 - Right to External Appeal Established. - (b) An insured, the insured's designee and, in connection with...

4911 - Powers of the Superintendent. - (b) If, after reviewing the application authorized by section four...

4912 - Standards for Certification. - (1) a description of the qualifications of the clinical peer...

4913 - Conflict of Interest. - (1) the health care plan; (2) any officer, director, or...

4914 - Procedures for External Appeals of Adverse Determinations. - (b) (1) The insured shall have four months to initiate...

4915 - Prohibited Practices. - (a) either a percentage of the amount by which a...

4916 - Oversight and Surveillance of the External Appeal Process. - (1) review the activities of the health care plans and...

4917 - Hold Harmless. - § 4917. Hold harmless. A health care provider requesting an...