New York State Health Care Reform Act (HCRA)
February 25, 2002
Removal of Clients from a Third Party Administrator's List of Electing Clients
This is a reminder to all third party administrators (TPA) that when you submit an Attachment 2.4-B (Election Form Addendum - Deletions) removing client(s) from your current list of electing clients, the corresponding Attachment(s) 2.5(Change of Payor Status for Payors) and/or Attachment(s) 2.6 (Change of TPA Status for Payors) MUST be signed by the payor and received by the Office of Pool Administration before the change can be processed. Consequently, to ensure proper processing, it is strongly encouraged that TPAs include the appropriate payor signed Attachment(s) 2.5 or 2.6 when submitting Attachment 2.4-B.
Attachment 2.4-B only acts as notification from a TPA that a client has been terminated. When a client terminates their relationship with a TPA, their reporting requirements to the Public Goods Pool do not cease. Until such time that the corresponding Attachment 2.5 or 2.6 is received, delinquency notices pertaining to outstanding reports will continue to be issued to the TPA of record.
Reports concerning outstanding claims incurred prior to a client's termination with a TPA must be filed with the Office of Pool Administration for one year following the end of the year in which the termination occurred or until all outstanding claims incurred prior to the termination have been adjudicated (paid) and the Office of Pool Administration has been notified of such by the payor.