In our aim to deliver unique, customized, and sophisticated service packages to our clients, our team will find the best strategy to fight against insurance carriers’ improper and arbitrary denials. The New York State Insurance Law provides healthcare practitioners with two options to recover money for services rendered to injured claimants. Disputes with insurance carriers can either be submitted to AAA arbitration or be filed in court.
We work with physicians and their attorneys to determine which approach will maximize their recovery and obtain the best results.
The Advantages of Arbitration
Generally, arbitration is less costly and time consuming than litigating a matter. Because the relaxed treatment of evidentiary rules in arbitration gives a slight advantage to insurance carriers presenting their defense, an arbitration is usually recommended if no dispute regarding the validity of the carrier’s claim process exists. In any event, the healthcare provider should make a cost/benefit analysis to determine whether litigation or arbitration is the best way to resolve the dispute.
The Process of Arbitration
The New York State Insurance Department designated the American Arbitration Association (“AAA”) to administer the no-fault arbitration process in the State of New York. The AAA must follow specific guidelines to arbitrate a no-fault dispute.
Filing A Claim with AAA
Generally An AAA arbitration filing includes:
1, A denial of claim (“NF-10”) form, with all fields completed;
2, An AAA form AR, with all questions answered (in the absence of an NF-10);
3, All bills in dispute;
4, The Assignment of Benefits (“AOB”) form; and
5, Any other information the applicant will rely upon at an arbitration hearing, should the hearing be necessary.
The filing should be sent to AAA, and a complete copy should also be sent to the insurance carrier. Any evidence the applicant submits after this initial filing will be marked as a late submission. The arbitrator then has the discretion of whether to consider this evidence.
Before an arbitration hearing, the case goes through a conciliation process. During this process, a conciliator assigned to the case contacts each party in an effort to save time and money by resolving the dispute without the need for a hearing. Any offers of settlement are made through the conciliator. Many cases filed for arbitration are resolved during this process.
Within 30 days of receiving notification from AAA of the applicant’s request for arbitration, an insurance carrier is required to submit all documents in support of its denial of the claims in dispute. Any evidence submitted beyond the 30-day period will be marked as a late submission and might not be considered by the arbitrator during hearing.
The AAA will mail a Notice of Hearing to each party at least 15 days prior to the hearing date. An arbitrator will be randomly assigned to hear the case and AAA case managers will provide administrative support throughout the arbitration process.
After a hearing is conducted and closed, an arbitrator writes a decision (the “award”) and delivers it within 30 days of the hearing’s closing. This award can be modified upon written application of a party within 21 days of delivery.
A party can appeal an award within 21 days of the award’s delivery. Accompanying a copy of the award, the party appealing will submit a letter outlining the grounds for appeal.
Service we offer:
We are experts in No fault billing and collection, hence each billing file is prepared with the no-fault collection’s process in mind. Our customized no-fault billing software is designed to keep all documents in an itemized and indexed format. If Arbitration is the venue for choice for a physician, our no fault billing system will prepare the file as it moves through the stages of billing, verifications, and denials.
We deliver a complete “Arbitration Ready” file to physician’s attorney, via email, FTP, and or any other preferred method.
Arbitration Ready File: Litigation ready file delivered to the physician’s attorney typically has the following items:
1, Assignment of Benefit
2, NF-3, The actual No-Fault Bill
3, The physician’s report
4, Medical reports or supporting medical documents
5, Proof of mail
6, Proof of delivery
7, All correspondence with the insurance company (verifications)
8, Proof of mail & delivery for all verifications
9, The actual Denial
Throughout all stages of Arbitration we provide full assistance and cooperation to physician’s collection’s attorney. If there are issues that an insurance carrier may raise to keep the physician from recovering money, we will assist the collection’s attorney to be the best of our ability.
You are entitled to recover money for the medical services you render to your patients. To learn more from us about No-Fault Arbitration, please call (516) 427-5400 for an immediate, free consultation.