STATE OF NEW YORK
25 BEAVER STREET
NEW YORK, NEW YORK 10004
|George E. Pataki
Gregory V. Serio
The Office of General Counsel issued the following opinion on September 29, 2003, representing the position of the New York State Insurance Department.
Re: Submission of No-Fault Assignments Via Facsimile Transmission
When a No-Fault health service provider submits an assignment of first party benefits from an eligible injured person to an insurer via a facsimile transmission, in order to receive payment for services rendered, and the insurer subsequently requests that the provider submit the original assignment form in order to establish proof of claim, does such request constitute a request for additional verification under the No-Fault regulation?
Yes. When a company receives a facsimile of an assignment of benefits to a No-Fault provider and requests the original assignment of benefits forms pursuant to 11 NYCRR 65-3.11(c), that request constitutes a request for additional verification under 11 NYCRR 65-3.5(b).
Pursuant to N.Y. Comp. Codes R. & Regs. tit. 11 § 65-3.5(k)(Regulation 68), every New York No-Fault insurer which writes more than 1,000 motor vehicle liability policies "shall establish procedures for the receipt of all claims, notices and verification by facsimile and/or electronic data transmittal." This provision permits an applicant health service provider to fax an assignment of benefits form to the No-Fault insurer, along with claims made for the payment of services rendered.
The regulation also provides, under N.Y. Comp. Codes R. & Regs. tit. 11 § 65-3.11(c), that "The insurer may request, in writing, the original assignment or authorization to pay benefits form to establish proof of claim The insurer must maintain the original form in its claim file." Therefore, in accordance with the cited provisions, an assignment of benefits prescribed form, submitted in conjunction with a verification of claim form, may be faxed to the insurer. However, when an insurer determines that a review of the original assignment form is necessary in order for the applicant to provide sufficient proof of claim, after receiving the faxed copy, it may then request that the original form be submitted.
When the insurer does request the original assignment form, such request would constitute a request for additional verification pursuant to N.Y. Comp. Codes R. & Regs. tit. 11 § 65-3.5(b), which permits an insurer to request additional information within 15 days after submission of an initial verification form, if such information is necessary to provide sufficient proof of claim. An insurer then has 30 days to pay or deny the bills submitted after receipt of the additional verification requested.
For further information one may contact Supervising Attorney Lawrence M. Fuchsberg at the New York City Office.