AMENDMENT TO NO-FAULT REGULATIONS, EFFECTIVE APRIL 1, 2013
Although the fourth amendment to Insurance Regulation 68-C has brought substantial changes to New York State’s No-Fault regulations,the true impact of these changes will not be known until litigation and arbitration decisions based on the new regulations become available.
Answer Verification Requests Within 120 Days.Pursuant to the amendment, the healthcare provider must now provide a response within 120 days of an insurer's verification request, or provide reasonable justification why the provider cannot do so. Not being able to get the documents constitutes a valid justification, but you must respond to the insurer. If the healthcare provider fails to answer or provide a justification in his answer, the amendment permits an insurer to deny the claim. Notably, this 120 day limit does not apply to an independent medical examination or an examination under oath.
Answer Verification Requests That Are Late.The amendment provides that an insurer's failure to comply with a prescribed time frame will not excuse a healthcare provider's duty to comply with the verification request. This means that healthcare providers should still answer verification requests, even if they are made more than 30 days after claim submission.