120.950 Regulation and Transparency of Imaging Benefit Managers’ Contracts
The Medical Society of State of New York will seek legislation that any health plan, or its business partner, conducting prior authorization for non-urgent and non-emergent services or procedures 1) respond to these requests within two business days; 2) utilize recognized standards of care and comply with any published specialty society-approved practice guidelines; 3) ensure that their authorization criteria conform with their health plan’s published policy available to the public for any and all service needing prior authorization; and 4) in the event of denied authorization, an expedited peer-to-peer appeal be conducted within the day (24-hour period) so that no potentially harmful delays befall the patient and that compliance with these rules be monitored by the NYS Department of Health. (HOD 2012-253; Reaffirmed HOD 2020-270)
