Every no-fault provider should be knowledgeable on the differences between accepting an “Authorization to Pay Benefits” (Box 20 of the NF-3) versus an “Assignment of Benefits”(Box 21 of the NF-3).4 Although both will permit the carrier to pay the provider directly for the services they render, the remedies for bills that are denied vary significantly. Accepting an authorization or assignment during an initial visit can determine if a provider will ultimately get denied bills paid after the denial.
An agreement to accept either an authorization or assignment is always voluntary on the part of the no-fault provider. The significant difference between the two is that the rights and obligations imposed by an Assignment of Benefits do not exist under an Authorization to Pay.
When a patient signs an “Authorization to Pay Benefits” form, they retain all the rights, privileges and remedies under the no-fault provisions of New York’s Insurance Law. This means that the provider can pursue a patient directly for payment should a bill be denied, but precludes the provider from bringing a legal claim against the carrier as the patient has retained this right.
On the contrary, an Assignment of Benefits expressly gives these rights and remedies to the provider but forbids a provider from pursuing the client directly. A provider can bring a claim in arbitration or court against the insurance carrier, but cannot seek reimbursement from the patient.
Ultimately, both an assignment and authorization permit a provider to receive payment for approved no-fault bills directly from a carrier. However, if a patient signs an Authorization to Pay and the bill is denied by the insurer, the provider must seek payment from the patient. Alternatively, if a patient signs an Assignment of Benefits and the bill is denied, the provider must pursue payment from the insurer via arbitration or court proceeding.
View a copy of the NF-3 Form
Have more questions about No-Fault Receivables?
Download a complimentary e-book, The Healthcare Provider’s Guide to New York State No-Fault Insurance, as seen this weekend at the NYSCA 2018 Spring Conference.
TonaLaw has been working with healthcare providers in New York for over 24 years. Many healthcare providers do not know how much they are owed in No-Fault receivables, or even for how long this money is owed to them for treating their injured patients.
This complimentary e-book provides answers to frequently asked questions so that you, the healthcare provider, can better treat your patients and get the money you are OWED for these treatments. We hope that it helps you an provides peace of mind about your healthcare business and New York No-State Insurance.