Maryland Medical Assistance Program and Health Insurance - Claims for Reimbursement - Downcoding

Summary

The bill prevents insurers, nonprofit health service plans, HMOs and managed‑care organizations from lowering the service code on a claim (downcoding) unless they follow strict review rules. It requires written notice, a clinical justification, and an opportunity for providers to contest the change, with the final decision made by a qualified physician. The measure aims to protect providers and patients from reduced payments that are not clinically justified.

AI-generated summary — may be incomplete or inaccurate. Verify against the official bill text.

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