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Title: Section 732-1.4 - Preferred Provider Organization Decertification

Effective Date


732-1.4 Preferred Provider Organization Decertification.

(a) The commissioner may revoke, suspend or amend the certification of any PPO if the commissioner finds that:

(1) the PPO fails to meet any of the requirements of this Part or Article 10-A of the Workers' Compensation Law, or fails to maintain compliance with the standards set forth in the application for certification.

(i) If the commissioner has reason to believe that such lack of compliance was unintentional and did not have a negative impact on any claimant, he or she may request from the PPO a plan of correction; and

(ii) if such plan of correction is accepted by the Commissioner and implemented, decertification shall not be required; or

(2) the PPO has knowingly provided false or misleading information in its application for certification.

(b) Decertification of a PPO shall preclude the organization and its principals from operating or being affiliated in any manner with a PPO certified pursuant to this Part for a period of not less than three years from the date of decertification.

(c) If the commissioner has reason to believe a medical or other health care provider or physician participating in a certified PPO fails to meet the requirements of Article 10-A of the Workers' Compensation Law or regulations promulgated pursuant thereto, he/she shall promptly provide information and documentation concerning such belief to the chair.

(d) The chair shall notify the commissioner of any providers disqualified from the PPO network under the Worker's Compensation Law.


VOLUME E (Title 10)