N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 325-1.3

Current through Register Vol. 46, No. 50, December 11, 2024

Section 325-1.3 - Reports of treating providers

In order to expedite the processing of claims and to avoid, so far as possible, the appearance of providers in contested bill proceedings, the rules with respect to filing of medical reports by treating providers are here stated:

(a) All medical reports filed by treating providers and specialists must be submitted to the insurance carrier, self-insured employer, or third-party administrator and the Board in the format prescribed by the Chair, which may be electronic.

(b) Every provider shall file all medical reports with the Chair, and also with the employer or the employer's carrier, if known, in the format prescribed by the Chair, which may be electronic, in the following intervals:

(1) within 48 hours following first treatment;

(2) within 15 days after filing the medical report filed within 48 hours after the first treatment;

(3) thereafter during continuing treatment and without further request, a progress report for each follow-up visit to be scheduled when medically necessary except the intervals between follow-up visits shall be no more than 90 days;

(4) when a claimant reaches the maximum medical improvement, which must include an opinion whether there is any permanent impairment, if any;

(c) Carriers, self-insured employers and third-party administrators may designate a single mailing address for mailing of paper medical reports and bills when such address has been published in the manner prescribed by the Chair and the provider is provided with actual notice of the mailing address.

N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 325-1.3

Amended New York State Register October 14, 2020/Volume XLII, Issue 40, eff. 10/14/2020