October 04, 2021
NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES AND NEW YORK STATE DEPARTMENT OF HEALTH DELIVER REPORT AND RECOMMENDATIONS TO REDUCE HEALTH CARE COSTS AND COMPLEXITIES FOR THE BENEFIT OF NEW YORK CONSUMERS
Recommendations from Stakeholders Across New York State’s Health Care Industry
The New York State Department of Financial Services (DFS), in conjunction with the New York State Department of Health (DOH), today delivered a report to the New York State Legislature with recommendations to reduce health care costs and complexities for the benefit of consumers, providers, and health insurers. The report reflects the year-long work of New York’s Health Care Administrative Simplification Workgroup, which was created by statute last year to study and evaluate this important issue. The Workgroup brought together representatives of the insurance industry, consumers, hospitals, physicians, behavioral health providers, brokers, and unions. Members of the Workgroup identified a number of ways to reduce health care costs and complexities through standardization, simplification, and technology. DFS and DOH thank all Workgroup members for their significant time commitment and valuable contributions.
Administrative costs are estimated to be as much as 30% of total health care costs. The Workgroup recommended solutions to address administrative inefficiencies and reduce costs for the benefit of all health care stakeholders, including most importantly consumers. Simplifying the administrative process relating to provider credentialing, preauthorization of services, claims submission, and other administrative issues allows health care providers and insurers to work together to provide better care for consumers.
“The Workgroup provided a unique forum for a diverse group of stakeholders to address critical areas to improve the health care payment and delivery systems for consumers, providers, and health plans,” said Acting Superintendent of Financial Services Adrienne A. Harris. “The recommendations in the report are a testament to what can be achieved when we work together to find solutions to make the health care system work better for New Yorkers.”
“Helping to ensure that health care is accessible and affordable for all New Yorkers is one of our top priorities in New York State,” said State Health Commissioner Dr. Howard Zucker. “In partnership with DFS, the Department has worked to bring together all stakeholders to simplify the process and reduce costs to benefit New Yorkers and their families.”
“When public health advocates and government partner to resolve challenges faced by consumers, providers and payers, access to good quality health care is improved,” said NYS OASAS Commissioner Arlene Gonzálaz-Sánchez. “The findings issued in this report demonstrate the effectiveness of true collaboration between stakeholders and decision makers that can have lasting, positive public health outcomes for New Yorkers.”
“Making healthcare less complex and less costly will make it easier for consumers to navigate the system and help increase access to care for the people who need it most,” said OMH Commissioner Dr. Ann Sullivan. “The workgroup has done an excellent job in identifying administrative red tape and complexities that can be simplified to lower costs for patients, insurers and healthcare providers.”
The Workgroup made 25 recommendations to reduce health care administrative costs and complexities. The Workgroup was required to consider provider credentialing, preauthorization practices, access to electronic medical records, claim submission and payment, claim attachments, and insurance eligibility verification. Additional topics such as facility fees, notification of hospital admissions, claim deadlines, health care claims reports, and utilization review were also discussed.
Recommendations to reduce administrative complexities for consumers include:
- Simplifying preauthorization. Health plans should clearly identify services that require preauthorization and annually review these services to identify where preauthorization may be removed. Reducing preauthorization requirements, or alternatively making them easier to find, helps consumers get quicker access to the care they need.
- Standardizing financial assistance forms. Hospitals should be required to use a uniform, standard financial assistance form (with standard eligibility criteria) for consumers to apply for financial assistance with hospital bills. The form should be easily accessible and publicly available on each hospital’s website, DOH’s website, and translated into languages other than English. These efforts will make it easier for consumers to understand and apply for financial assistance with hospital bills.
- Making clinical review criteria more transparent. Health plans should post their clinical review criteria on their websites and make them available within five days of a request. This ready access to clinical review criteria allows consumers to be better informed about when care is covered for specific health conditions.
- Standardizing forms. Health plans should use a standard form for an insured to designate an authorized representative and the form should be accepted by all health plans, which will make it easier for consumers to obtain assistance in dealing with their health plan.
Other important recommendations include:
- Simplifying credentialing. Health plans should use uniform credentialing applications and implement online portals or telephone hotlines for providers to obtain information on the status of their applications. Providers should ensure that their credentialing information is complete. Health plans and providers should collaborate to explore the feasibility of an independent, centralized credentialing database.
- Encouraging access to electronic medical records. Health plans and providers should continue to discuss a path forward for providing access to electronic medical records and options to streamline the exchange of medical records.
- Encouraging electronic claims submission. Providers should submit claims electronically, where possible, instead of by paper or facsimile, and health plans should accept claims that are submitted electronically.
- Sharing insurance coverage information. Health plans should make information regarding an insured’s coverage and benefits available to providers electronically.
- Improving communication. Health plans and hospitals should work collaboratively to develop standard terms, definitions, and methodologies to improve communication and reduce inefficiencies relating to claims activity.
For a full overview of the Workgroup’s recommendations, read the report available on the DFS website.