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Information for Providers on Subrogation

New York State Department of Health
New York Early Intervention System (NYEIS) Electronic Mailing List

Information for Providers on Subrogation (with Attachment )

 


Dear Colleague:

Pursuant to NYS Public Health Law (PHL) section 2559(3)(d), approved early intervention providers are subrogated to the rights an eligible child and his or her family may have or be entitled to from an insurer or health maintenance organization for services rendered by providers to the child and family that are covered under an insurance policy, plan or benefit package. Providers must submit notice to the insurer or plan administrator of their exercise of the right of subrogation upon the provider's assignment as the early intervention service provider for the child. NYS Insurance Law section 3235-a(c) states that a right of subrogation exercised by a provider under PHL section 2559 is valid and enforceable against the commercial insurer to the extent benefits are available under the insurance policy. The insurer or plan administrator must accept claims submitted by an approved early intervention provider who has submitted prior written notice of intent to exercise subrogation rights, for any early intervention services for which benefits are available to the insured child.

A template for notice of intent to exercise subrogation rights is attached to this e-mail. This template has also been made available in the Communications MS Word template repository in NYEIS. Providers should use this subrogation template to send written notice of intent to exercise subrogation rights to the insurer or plan administrator for each child on their caseload with commercial insurance coverage. Users can download the Required Notice of Subrogation template to their desktop and fill in the data manually to populate it with child and provider specific information. Providers must maintain documentation of the subrogation notification in the child’s record.

The Communications MS word feature in NYEIS can be accessed by clicking the Communications link off of the child's Integrated Case Homepage. The user can then click the Create MS Word button and create the communication. The template can be accessed by clicking on the search icon next to the Template Name field at the bottom of the page and selecting the Subrogation Notice template from the list.

We hope this information is helpful. Questions regarding subrogation can be sent to bei@health.state.ny.us.

Thank You


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Article ID: 59, Created On: 5/9/2013, Modified: 10/28/2015

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