§ 4913. Conflict of interest. 1. No external appeal agent or officer, director, or management employee thereof; or clinical peer reviewer employed or engaged thereby to conduct any external appeal pursuant to this title, shall have any material professional affiliation, material familial affiliation, material financial affiliation, or other affiliation prescribed pursuant to regulation, with any of the following:

Terms Used In N.Y. Public Health Law 4913

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.

(a) the health care plan;

(b) any officer, director, or management employee of the health care plan;

(c) any health care provider, physician's medical group, independent practice association, or provider of pharmaceutical products or services or durable medical equipment, proposing to provide or supply the health service;

(d) the facility at which the health service would be provided;

(e) the developer or manufacturer of the principal health service which is the subject of the appeal; or

(f) the enrollee whose health care service is the subject of the appeal, or the enrollee's designee.

2. Notwithstanding the provisions of subdivision one of this section, the commissioner shall promulgate regulations to minimize any conflict of interest where such conflict may be unavoidable.

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