NY A02352

Health care professionals who have at least 90% of their preauthorization requests approved by an insurer for a specific service during a six-month evaluation period automatically qualify for preauthorization approval for that service

Insurers must complete initial evaluations within 180 days of the law's effective date, with automatic approvals becoming effective at 225 days; annual evaluations must be completed by November 15th for January 1st implementation

Services provided under automatic preauthorization are deemed medically necessary, and insurers must pay claims promptly without denying, withholding, or reducing payment for medical necessity reasons

Insurers may only rescind automatic approval effective January of each year if less than 90% of claims met medical necessity criteria during retrospective review, with 30 days advance notice required

Insurers cannot retroactively deny or recoup payments for services covered by automatic preauthorization unless the provider knowingly misrepresented the service with intent to deceive or failed to substantially perform the service