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

Summary

The bill bars insurers, nonprofit health service plans, HMOs and managed‑care organizations from lowering the service code on a claim to reduce payment, except under strict rules. It forces them to give providers advance notice, explain the change, allow a response, and have a board‑certified physician make the final decision, which can be appealed. The goal is to protect providers and patients from unfair payment reductions.

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

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