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Third Party Administrator (TPA) or Administrative Services Only (ASO) Election Application NEW YORK STATE DEPARTMENT OF HEALTH Division of Finance and Rate Setting HEALTH CARE REFORM ACT PUBLIC GOODS.

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HCRA is a major component of New York State´s Health Care financing laws which governs hospital reimbursement methodologies and targets funding for a multitude of health care initiatives.

Electronic Filing User ID Application. HEALTH CARE REFORM ACT – PUBLIC GOODS POOL. DOH-4264 INSTRUCTIONS. All electing payors/third party administrators (TPA)/administrative services only (ASO) organizations and designated providers are required to file Public Goods Pool reports electronically.

Phone. 1-800-663-6114 - Complaints/Inquiries (Monday-Friday 9:00 a.m - 5:00 p.m.)

If your insurance carrier did not pay this tax or you do not have health care coverage, you are responsible for paying the NY State Surcharge and we are required to pay the collected surcharge to New York State. Why do I keep getting bills?

Indigent care surcharge For services delivered from April 1, 2009, through the end of 2026, the surcharge is 9.63% for electing payors that pay this expense to the Public Goods Pool and an additional 28.27% (or a total of 37.9%) for nonelecting payors that pay the surcharge to providers.

The additional surcharge can be as high as 60 percent. In addition, the group will be charged a monthly administrative fee of $1.25 per employee on your monthly bill due to non-participation.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232