12 CRR-NY 325-5.2NY-CRR

STATE COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK
TITLE 12. DEPARTMENT OF LABOR
CHAPTER V. WORKERS' COMPENSATION
SUBCHAPTER C. MEDICAL PROVIDER AUTHORIZATION
PART 325. MEDICAL AND SURGICAL CARE AND TREATMENT
SUBPART 325-5. COMPUTER MATCH BETWEEN HEALTH INSURERS AND WORKERS' COMPENSATION CARRIERS
12 CRR-NY 325-5.2
12 CRR-NY 325-5.2
325-5.2 Definitions.
As used in this Subpart:
(a) Accident shall include both an accident arising out of and in the course of employment and an occupational disease. In the case of occupational disease, date of accident, where used in this Subpart, shall mean date of disablement.
(b) Acceptance of claim shall mean the filing of notice in the format prescribed by the chair of the carrier’s acceptance of a claim of benefits.
(c) ANCR shall mean accidental injury or occupational disease, notice and causal relationship.
(d) Board shall mean the Workers' Compensation Board, and in the case of board determinations shall include those made by a member or panel of the board, by a Workers' Compensation Law judge, conciliator or by the full board.
(e) Carrier shall mean a self-insured or uninsured employer, or workers' compensation insurance carrier as defined in section 300.1(a)(7) of this Title, or special fund created by the Workers' Compensation Law for payment of workers' compensation claims, but shall not include the uninsured employers' fund.
(f) Chair shall mean the Chairperson of the Workers’ Compensation Board of the State of New York.
(g) Health insurer shall mean a health insurer, health benefits plan or other payor of health benefits as defined in section 13(d) of the Workers’ Compensation Law, when acting directly or through a HIMP agent.
(h) HIMP means the Health Insurance Matching Program authorized by section 13(d) and (h) of the Workers’ Compensation Law and refers to processes established by the board to assist a health insurer in reimbursement from a carrier for payments made for medical and/or hospital services for or on behalf of an injured employee, and for arbitration of disputed claims for reimbursement.
(i) HIMP agent shall mean a person or entity that is designated and authorized by a health insurer to submit information for matching under this Subpart and to seek reimbursement from a carrier under Subpart 325-6 of this Part on behalf of the health insurer. A HIMP agent must execute a written agreement, prescribed by the chair, between the HIMP agent, the health insurer and the board and file such agreement with the board. In addition a HIMP agent must comply with all laws, regulations and policies applicable to health insurers as set forth in Workers’ Compensation Law section 13(d) and (h), and this Part. Failure to comply with all terms of such written agreement or such other agreements with the board or with all applicable laws, regulations, and policies is grounds for termination of an individual or entity’s status as HIMP agent and to preclude its participation in and rights under Workers’ Compensation Law section 13(d) and (h), and this Part.
12 CRR-NY 325-5.2
Current through August 31, 2021
End of Document

IMPORTANT NOTE REGARDING CONTENT CURRENCY: The "Current through" date indicated immediately above is the date of the most recently produced official NYCRR supplement covering this rule section. For later updates to this section, if any, please: consult editions of the NYS Register published after this date; or contact the NYS Department of State Division of Administrative Rules at [email protected]. See Help for additional information on the currency of this unofficial version of NYS Rules.