265.980 Enhancements to HMO Prompt Payment:
MSSNY will petition the Governor of the State of New York to modify the current Prompt Payment Law to provide for the imposition of a penalty of up to 20% of the amount billed, payable directly to the physician by the payor, for any clean claim not paid within the 45-day time frame. The Prompt Payment Law should also be modified to include payment to the physician of punitive damages for clean claims not processed or paid within 45 days when it can be shown that an intentional “pattern of abuse” exists on the part of the HMO, ERISA plan, or insurance company. When an intentional pattern of abuse is found to be exhibited by an HMO, ERISA plan, or insurance company in not paying physicians’ claims within the prescribed 45-day limit, that the HMO’s license be subject to suspension or revocation. The Prompt Payment Law be further amended to reflect that in the event suspension or revocation of license is not forthcoming, that the New York State Insurance Department be granted the legislative authority to mandate that these efficient HMO, ERISA plan, or insurance companies be required to increase their monetary reserves by 25%, and that managed care plans be required to provide written proof of “unclean claims.” (HOD 1999-72; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
