N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 325-6.7

Current through Register Vol. 46, No. 45, November 2, 2024

Section 325-6.7 - Initiation of arbitration

(a)

(1) The health insurer shall initiate the request for arbitration by serving the completed HIMP-1 form requesting arbitration and supporting documents on the carrier.

(2) The health insurer shall serve two copies of the completed HIMP-1 form requesting arbitration and supporting documents, proof of service of the request for arbitration upon the carrier, and the prescribed filing fee on the dispute forum.

(3) In the event that the carrier has failed to serve a notice of objection to the request for reimbursement within 90 days in accordance with section 325-6.4 of this Subpart, the health insurer shall state in the request for arbitration that no objections have been received and shall provide proof of service of the initial HIMP-1 form upon the carrier.

(b) Upon receipt of the completed request for arbitration, the dispute forum shall acknowledge receipt of the request for arbitration by notifying both parties. Any request for arbitration which is not accompanied by the completed form, proof of service and/or the required fee shall not be processed and shall be returned to the health insurer. Any objection for improper or untimely service of a HIMP request or request for arbitration shall be an issue to be determined by an arbitrator. The defense of improper or untimely service of a reimbursement or arbitration request must be raised within 14 days after the date of acknowledgment of the completed request for arbitration from the dispute forum.

(c) Within 14 days after the date of acknowledgment of the completed request for arbitration from the dispute forum, the carrier shall serve on the dispute forum two copies of all documents supporting its objections to the requests for reimbursement, together with proof of timely service of such documents upon the health insurer. Except as provided in section 325-6.11(c) of this Subpart, such documents will not be considered by the arbitrator, unless the carrier has previously served a timely notice of objection and such supporting documents with the health insurer in accordance with section 325-6.4 of this Subpart. The carrier shall place the dispute forum's case identification number on each document.

(d) In the event that the carrier serves documents or other materials on the dispute forum that it did not previously serve upon the health insurer, the health insurer shall have ten days to respond to such documents or other materials.

N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 325-6.7

Adopted New York State Register April 6, 2016/Volume XXXVIII, Issue 14, eff. 6/1/2016