New York No-Fault
New York No-Fault arbitrations are filed with the American Arbitration Association. Under New York law, a medical provider may file a claim against the insurance company if they have not received payment of a submitted no-fault claim. Please note that New York does not pre-certify or pre-qualify no-fault patients for medical treatment.
Under the New York No-Fault Statutes, all claims for payment must be submitted to the carrier within forty –five (45) days of the date of service. Furthermore, response(s) to a carrier’s ‘request for further verification’ must be submitted within one hundred and twenty (120) days of date the request was received. Proof of timely submission of both the billing claim form and any verification response sent to the carrier is essential under New York law because in New York the insurer may deny payment of a no-fault claim for untimely submission. Likewise, in those instances in which a carrier has failed to respond to a no-fault bill in any way, the medical provider must establish timely submission of its bill in order to be eligible for payment.
For those cases in which payment of your New York No-Fault claim is denied due to an alleged “lack of medical necessity” by the carrier, you as the medical provider have the opportunity to arbitrate your claim and must submit your medical records as well as the medical records of your patients other treating doctors and an affidavit of medical necessity challenging and rebutting the allegations of the insurance carrier’s medical report. De Frank, McCluskey & Kopp is on hand to guide you through this process and answer any questions you may have regarding your unpaid New York No-Fault/PIP claims.
The items listed below with an asterisk must be provided. The other information is helpful, and should be provided.
- NY Assignment of Benefits*;
- Unpaid NF-3 NY No-Fault billing claim form(s)*;
- Denial of claim form(s) received for unpaid NY PIP claims*;
- A copy of the Peer Review or IME report.
- Copy of the carrier’s verification request (if applicable)*;
- A copy of the verification Response submitted to insurance carrier (if applicable)*
- Proof of mailing of unpaid New York No-Fault billing claim form(s)*; and
- Proof of mailing of each verification response submitted to the insurance carrier
- Available medical records for each patient – initial examination, follow-up evaluations, MRI reports, patient evaluations conducted by other treating practitioners, operative reports, and EMG/NCV reports*;
Kindly note that for those NY No-fault claims that have been denied payment for an alleged lack of medical necessity by the carrier, a rebuttal affidavit of medical necessity addressing the insurer’s peer review report and/or IME report will need to be submitted as part of the initial Arbitration package.
The medical provider has two options. The medical provider can prepare their own rebuttal report or have the company that we have contracted with prepare the rebuttal report on your behalf. The company’s fee is between $25.00 and $45.00 depending on the complexity of the report. The medical provider is responsible for paying the rebuttal report. We will advance the fee on behalf of the medical provider. You will be provided with an invoice from the company.
To send a NY-No Fault file to our firm to file, it is best to send the file electronically. Kindly email same to firstname.lastname@example.org. If you prefer regular mail, kindly send same to De Frank, McCluskey & Kopp, LLC, 30 Galesi Drive, Suite 304, Wayne, NJ 07470 or by fax to 973-837-8550.
Please contact our office manager, Donella Hunt, at 973-696-1900 for a distinct user ID and password which allows you to view your facility’s case statuses.