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NYS Council Survey re: Compliance with Part AA
This brief survey will assist the NYS Council to compile information about the current status of health plan compliance with Part AA - the new commercial rate mandate implemented in last year's state budget. Specifically, we need a list of commercial insurance companies operating in NYS that are not in full compliance with Part AA, and we need some information as to the magnitude of the problem facing providers that are waiting for correct and full reimbursement for these services.
PLEASE help us to help you by gathering your responses to our questions (below) as soon as possible and sharing your response with Lauri at: lauri@nyscouncil.org.
1.
Name of Agency
2.
Person Reporting the information requested below
Name:
Phone Number:
Email Address:
3.
Does your agency currently serve New Yorkers with commercial insurance?
Yes
No
4.
If 'yes' are you currently awaiting reimbursement from a commercial plan or plans for more than 2 months?
Yes
No
5.
How much money are you owed by all of the insurers (combined) where the plans are at least 2 months in arrears with full payment at the correct rates?
6.
Have you recently (within the last 9 months) tried to secure a contract and go 'in network' with a commercial plan, only to be informed by the insurer that it is not currently accepting new providers in its network at this time?
Yes
No
7.
If yes, please tell us which plans have told you this?
Name of plan:
Name of plan:
Name of plan:
Name of plan:
For CCBHC Demo agencies (only the original cohort of 13 Demos, established years ago)
8.
Have you been billing insurers your PPS rate for commercial services provided to beneficiaries covered under a fully funded insurance policy?
Yes
No
9.
How many commercial insurers are you 'in network with' at this time?
10.
How many of the plans you are contracted with are paying the correct PPS rate as required under the new commercial rate mandate?
11.
To date, please estimate how much you are owed (in total) by commercial plans you are contracted with that are either not paying the correct PPS rate (or not paying a rate at all) for fully funded commercial services?
For non-CCBHC Demo agencies
12.
Have you been billing insurers the Medicaid APG government rate for commercial services provided to their beneficiaries who are enrolled in a fully funded plan?
Yes
No
13.
If yes, how much money are you owed by all commercial insurers combined for commercial services that are eligible for the new commercial rate mandate, where the funds are at least 2 months late?
14.
Please identify the insurers that are NOT reimbursing you the correct amount at this time:
Name of insurer:
Name of insurer:
Name of insurer:
Name of insurer:
DFS Complaint Process
15.
Have you filed a complaint regarding a commercial insurer/s you are 'in network' with where the insurer is either not paying the correct rate or is not paying anything for claims you have filed that are eligible for the new Part AA commercial rate mandate?
Yes
No
16.
If 'yes' how long did it take for your complaint/s to be assigned to a complaint manager at DFS?
17.
If you filed a complaint with DFS more than 6 weeks ago and you are still waiting for your case to be assigned to a complaint manager, did you also write to the OMH commercial mailbox with your concern and did you receive a timely response from OMH?
Yes
No
18.
Did OMH help you to resolve the issue?
Yes
No
Thank you for your assistance!