2010 New York Code
PBH - Public Health
Article 28 - (2800 - 2822) HOSPITALS
2807-E - Uniform bills.

§  2807-e.  Uniform  bills.  1.  Definitions. For the purposes of this
  section, unless the context clearly requires otherwise:
    (a)"Ambulatory care services" shall mean ambulatory surgical services,
  diagnostic  and  treatment  services,   emergency   services,   hospital
  outpatient services and physician services.
    (b) "Superintendent" shall mean the superintendent of insurance.
    (c)  "Third-party  payor"  shall  mean  those  payors within the payor
  categories specified in paragraphs (a) and (b)  of  subdivision  one  of
  section  twenty-eight  hundred  seven-c  of  this  article,  except  for
  payments made for persons who are eligible  as  beneficiaries  of  title
  XVIII of the federal social security act (medicare).
    (d)  "Bill," other than a patient bill, shall include a claim form for
  a third-party payor.
    2. Uniform bills. (a) Notwithstanding any inconsistent  provisions  of
  law,  the  commissioner  shall, on or after July first, nineteen hundred
  ninety-five, develop a uniform patient bill for the purpose of providers
  providing a health care consumer with a patient bill  for  hospital  and
  health-related  services,  in  consultation  with  the superintendent of
  insurance,  statewide  organizations  representative  of  providers   of
  hospital and health-related services, third-party payors as described in
  paragraphs  (a) and (b) of subdivision one of section two thousand eight
  hundred seven-c of this article,  and  representatives  of  health  care
  consumers.  Such  patient  bill  shall be in such form and shall contain
  such information as  may  be  required  in  accordance  with  rules  and
  regulations  developed  by  the  commissioner,  provided  that  distinct
  uniform patient bills may  be  developed  for  each  type  or  level  of
  health-related service.
    (b) No provider of hospital or health-related services shall provide a
  health care consumer with any patient bill, on or after September first,
  nineteen  hundred  ninety-five,  for  services provided to such consumer
  except such uniform  patient  bill  as  developed  by  the  commissioner
  pursuant to paragraph (a) of this subdivision.
    (c)  Notwithstanding any inconsistent provision of this article or any
  other  law,  beginning  on  or  after  April  first,  nineteen   hundred
  ninety-four,  each  general  hospital providing inpatient services shall
  use a uniform data set, developed by the  commissioner  in  consultation
  with  representatives  of  providers  and  third-party  payors,  for the
  purpose of billing a third-party payor for inpatient services containing
  such information as  may  be  required  in  accordance  with  rules  and
  regulations of the commissioner.
    (d)  Notwithstanding any inconsistent provision of this article or any
  other law, beginning on  or  after  September  first,  nineteen  hundred
  ninety-four,  each general hospital, diagnostic and treatment center, or
  ambulatory surgery center providing ambulatory care services shall use a
  uniform  bill,  developed  by  the  commissioner  in  consultation  with
  representatives  of providers and third-party payors, for the purpose of
  billing a third-party payor for ambulatory care services containing such
  information as may be required in accordance with rules and  regulations
  of the commissioner.
    (e)  Notwithstanding any inconsistent provision of this article or any
  other law,  beginning  on  or  after  January  first,  nineteen  hundred
  ninety-five,  each  physician  providing  physician services shall use a
  uniform  bill,  developed  by  the  commissioner  in  consultation  with
  representatives  of providers and third-party payors, for the purpose of
  billing a third-party  payor  for  physician  services  containing  such
  information  as may be required in accordance with rules and regulations
  of the commissioner.

(f) Notwithstanding any inconsistent provision of this article or  any
  other  law, the commissioner in consultation with the superintendent and
  the commissioner of  social  services  shall  establish  procedures  for
  requiring  any payor for inpatient services, ambulatory care services or
  physician  services  making  payment  pursuant to the provisions of this
  section to utilize a uniform bill for patient services required pursuant
  to paragraphs (c), (d) and (e) of this subdivision.
    * 3. Fiscal intermediary. Notwithstanding any  inconsistent  provision
  of  law,  the commissioner shall not enter into an agreement for a pilot
  program  which  provides  for  among  its  purposes  a   single   fiscal
  intermediary  for  the  processing of hospital bills in a region, unless
  the commissioner shall  first  notify  the  chairs  of  the  senate  and
  assembly  standing  committees  on  health  not  less  than  one hundred
  twenty-days prior to entering into  such  agreement.  Such  notification
  shall include, but need not be limited to, the following:
    (a)  the  source  of  funding  and  anticipated  expenditures for such
  program;
    (b) the geographic region and participants in such program;
    (c) the nature and policy objectives of such  program,  including  its
  relationship  to  long  range  policy  objectives, and including but not
  limited to its relationship to establishing a universal health insurance
  coverage system;
    (d)  a  discussion  of  the  design,  proposed   implementation,   and
  time-frames for such program; and
    (e)   a   copy   of  any  proposed  agreements  or  other  contractual
  arrangements relating to the program.
    In the event the commissioner subsequently enters  into  an  agreement
  for  such a pilot program the commissioner shall promptly provide a copy
  of such agreement to such chairs. The commissioner  shall  report  every
  six  months thereafter on the progress of implementation of such program
  and provide a final evaluation of the program upon its conclusion.
    * NB Expires July 1, 2011
    4. Electronic transfer of claims information. (a) Claims submitted  to
  third-party  payors for payment for inpatient hospital services provided
  by a  general  hospital  on  or  after  April  first,  nineteen  hundred
  ninety-four  shall  be  submitted  in electronic formats consistent with
  this section.
    (b) Claims for payment made to third-party payors for ambulatory  care
  services provided by a general hospital, diagnostic and treatment center
  or ambulatory surgery center on or after January first, nineteen hundred
  ninety-five  shall  be  submitted  in electronic formats consistent with
  this section.
    (c) Claims for  payment  made  to  third-party  payors  for  physician
  services  on  or after July first, nineteen hundred ninety-five shall be
  submitted in electronic formats consistent with this section.
    (d) The provisions of this section  shall  not  apply  to  claims  for
  payment  to  third-party  payors  for  which the content, processing and
  payment thereof are regulated  solely  by  federal  law  or  regulation,
  provided,   however   that   such  third-party  payors  may  voluntarily
  participate in the electronic submission of claims information.
    (e) Consistent  with  their  capabilities  hospitals,  diagnostic  and
  treatment  centers,  physicians,  other  practitioners  and  third-party
  payors  may  be  permitted  to  elect  to  submit   claims   information
  electronically prior to the above dates.
    (f)  The  commissioner shall delay or waive the implementation of this
  section in particular instances for diagnostic and treatment centers  or
  practitioners  and, in consultation with the superintendent, third-party

payors where such diagnostic and  treatment  centers,  practitioners  or
  third-party payors have a small volume of services or business.
    (g)  The commissioner, in consultation with the superintendent and the
  commissioner  of  social  services,  shall  establish   procedures   for
  requiring  third-party  payors  to  accept  the electronic submission of
  claims information  for  inpatient  or  ambulatory  care  services  made
  pursuant to the provision of this section.
    5.  The  commissioner,  in consultation with the superintendent, shall
  make recommendations, to the legislature, by  June  thirtieth,  nineteen
  hundred   ninety-four,   for  improving  the  efficiency  of  processing
  electronic claims by  health  care  providers  and  third-party  payors;
  including   but   not   limited,   to   the  use  of  electronic  claims
  clearing-house.