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The Laws of New York
Consolidated Laws of New York
CHAPTER 45
Public Health
ARTICLE 49
Utilization Review and External Appeal
TITLE 2
Right to External Appeal
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SECTION 4914
Procedures for external appeals of adverse determinations
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TITLE 2
Right to External Appeal
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SECTION 4916
Oversight and surveillance of the external appeal process
This entry was published on 2014-09-22
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SECTION 4915
Prohibited practices
Public Health (PBH) CHAPTER 45, ARTICLE 49, TITLE 2
§ 4915. Prohibited practices. An external appeal agent shall not, with
respect to external appeal activities, permit or provide compensation or
anything of value to its employees, agents, or contractors based on:

1. either a percentage of the amount by which a claim is reduced for
payment or the number of claims or the cost of services for which the
person has denied authorization or payment; or

2. any other method that encourages the upholding of an adverse
determination.