120.886 Elimination of the Median in-Network Rate from Consideration at State Independent Dispute Resolution
MSSNY will advocate for (1) absolute clarity in how the median in-network rate is being calculated; (2) a requirement that insurers provide the median in-network rate in their EOBs to out-of-network providers if they wish to use this rate as a consideration at IDR; and (3) a mechanism for providing the disputing physician with the raw data from which the insurer calculated the median in-network rate so they can independently confirm its accuracy.
MSSNY will also advocate for removing the median in-network rate as a required consideration for the New York State IDR process. (HOD 2023-53)
