N.Y. Comp. Codes R. & Regs. tit. 11, § 217-2.2 – Coordination of benefit requirements.

(a) When a health care provider submits a claim to a health insurer, that submission shall suspend the time period for submission of the claim to a second health insurer until such time as the provider has received a remittance advice or other evidence of a benefit determination, including an appeal determination, from the first health insurer. After the health care provider receives a remittance advice, appeal determination, or other evidence of a benefit determination from the first health insurer, the health care provider shall have at least 60 days from receipt of the remittance, appeal determination or other evidence of a benefit determination to bill any other health insurer that has a potential payment obligation. A claim submitted to the second health insurer after the 60-day period shall be subject to the claims submission rules of the second health insurer. Unless the health care provider is otherwise able to demonstrate, it shall be presumed that the remittance advice, appeal determination, or other evidence of a benefit determination was received within eight calendar days of the date on the document.
1. (1) If a health care provider submits a claim to a secondary health insurer prior to submitting the claim to the primary health insurer, the secondary health insurer shall deny the claim, notify the health care provider that it is secondary and notify the health care provider of the identity of the primary health insurer, or, if the identity of the primary health insurer is not known, provide whatever information was used to make the determination that it is a secondary health insurer. The secondary health insurer may provide the information by referring the health care provider to the specific page of the secondary health insurer’s website and shall include a toll free telephone number through which the information will be provided. The health care provider’s submission of the claim to the primary health insurer shall suspend the time period for resubmission of such claim to the secondary health insurer as set forth above in subdivision (a) of this section.
2. (2) If the information provided by the secondary health insurer is not sufficient to determine the identity of the primary health insurer, the health care provider shall have 60 days from the notice that other coverage may exist to make a reasonable effort to confirm if other coverage does exist. A “reasonable effort” shall include at least an attempt by the health care provider to contact the patient.
3. (3) If the health care provider is unable to confirm other coverage within 60 days as provided in paragraph (2) of this subdivision, the secondary health insurer shall process the claim in accordance with the provisions in the health insurance policy, provided that the health care provider resubmits the claim to the secondary health insurer, with copies of the documents to support the health care provider’s efforts to confirm other coverage, within 30 days of the determination that other coverage could not be confirmed despite reasonable efforts.
  (c)
4. (1) If a secondary health insurer makes a payment to a health care provider prior to determining the secondary health insurer’s actual obligation to pay the claim, the secondary health insurer shall delay any action to recover the payment, pending a determination by the primary health insurer as to the primary health insurer’s obligation and a determination by the secondary health insurer of its actual obligation to pay the claim. Subject to all provisions of this subdivision, the secondary health insurer may recover the payment if the health care provider does not submit a remittance advice, appeal determination, or other evidence of a benefit determination from the primary health insurer to the secondary health insurer within 120 days of the secondary health insurer’s notification that other coverage exists. Nothing herein shall prevent the secondary health insurer from allowing more than 120 days to submit the documents
5. (2) If the information provided by the secondary health insurer is not sufficient to determine the identity of the primary health insurer, the health care provider shall have 60 days from the notice that other coverage may exist to make a reasonable effort to confirm if other coverage does exist. A “reasonable effort ” shall include at least an attempt by the health care provider to contact the patient.
6. (3) If the health care provider is unable to confirm other coverage within 60 days as provided in paragraph (2) of this subdivision, the secondary health insurer shall process the claim in accordance with the provisions in the member’s health insurance policy, provided that the health care provider notifies the secondary health insurer and forwards copies of the documents to support the health care provider’s efforts to confirm other coverage, within 30 days of the determination that other coverage could not be confirmed despite reasonable efforts.
(b)
(d) If a health care provider receives approval from a health insurer to provide services to the health insurer’s insured, prior to the rendering of those services to the insured, a second health insurer shall not subsequently deny a claim for the services on the basis that no prior approval from that health insurer was received. The fact that one health insurer has given a health care provider prior approval does not, however, preclude another health insurer from determining that the services that were provided were not medically necessary or otherwise not covered under the policy.
(e) Every determination of the primary health insurer and secondary health insurer shall comply with section 3224-a of the Insurance Law.