NYSCA Special Announcement Retrospective Audit Bill Passes

The NYSCA is pleased to share with you the news that the Association’s hard work has been rewarded. Bill A8402 has been passed both the Assembly and the Senate. It now awaits Governor David Paterson’s signature for final approval. Included in this omnibus piece of legislation was the language of NYSCA’s retrospective audit bill.

This bill will limit the period of time a health care plan can “look back,” when conducting a retrospective audit, to a maximum of two years. Prior to this, providers who contract with health benefit plans and their subsidiaries were bound by the “look back” period in the participating provider agreement or, if the agreement was silent on this score, in theory a health benefit plan could “look back” six years to make adjustments, the period of time permitted by the statute of limitations for contractual disputes under New York’s Civil Practice Law and Rules (CPLR). (Non-participating providers (out-of-network providers) are not bound by contract law and, in theory, a health benefit plan is not limited in time on how far back the plan can “look back” when conducting a retrospective audit.) The Association’s original bill was sponsored by Vito Lopez in the Assembly and Eric Delan in the Senate and they were both instrumental in championing the omnibus bill on the profession’s behalf. In addition, when the NYSCA and the New York Chiropractic Council jointly conducted a legislative lobbying day in Albany, attendees met with staff members for Neil Breslin of the Senate Insurance Committee and Joe Morelle, Chairman of the Assembly Insurance Committee. We owe them and our lobbyists, our gratitude and appreciation. Several other key points of the bill are: • Requiring that a provider be given notice of an adverse reimbursement change to a provider contract and an opportunity to cancel the contract. • Requiring insurers and HMOs to pay electronic claims promptly and limit their ability to respond to claims by sending a coordination of benefits questionnaire. • Permitting newly licensed providers and providers moving to New York to be provisionally Credentialed until the credentialing determinations is made by the insurer or HMO. The bill includes many other provisions. The bill includes many other provisions. It can be seen in its entirety by clicking on the bill number A8402. As leaders of the state Association, thank you for your continued support and dedication to NYSCA and the Chiropractic profession. Without your support, this victory would not have been possible. Dr. Bruce Silber, President Dr. Lou Lupinacci, Vice President Dr. Don Littlejohn, Treasurer Dr. James Hildebrand, Secretary


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