Department of Civil Service
New York State Health Insurance Program: Selected Manually Processed Claims In the New York State Health Insurance Program, the Department of Civil Service administers health insurance programs for active and retired State and local government employees and their dependents. The primary such program is the Empire Plan, which provides services costing about $4.0 billion a year. In the Empire Plan, insurance coverage for medical, surgical and hospital services is provided by two insurance carriers. Most of the medical claims received by the two insurance carriers are processed automatically through computerized claims processing systems. However, some claims are processed manually. We examined certain of these manually processed claims at one of the insurance carriers and found that they were not always processed correctly. On the basis of our random sample, we estimated that, during the 30-month period covered by our audit, a total of about $3.7 million was overpaid on these claims. We recommended that certain actions be taken by the insurance carrier to prevent such overpayments.
For a complete copy of Report 2005-S-56 click here.
For a copy of the 90-day response click here.