Maryland HB1153 regulates downcoding of health insurance claims, requiring insurers to notify providers of downcoding intent and decisions, and.

Maryland HB1153 aims to regulate the practice of downcoding in health insurance claims, where insurers alter service codes to reduce reimbursement. The bill mandates that insurers, nonprofit health service plans, and health maintenance organizations provide notice to health care providers before downcoding a claim, including reasons based on clinical criteria and coding guidelines. It prohibits downcoding based solely on automated processes without clinical review and requires a physician's final decision on downcoding.

Maryland HB1153 regulates downcoding of health insurance claims, requiring insurers to notify providers of downcoding intent and decisions, and.

Maryland HB1153 aims to regulate the practice of downcoding in health insurance claims, where insurers alter service codes to reduce reimbursement. The bill mandates that insurers, nonprofit health service plans, and health maintenance organizations provide notice to health care providers before downcoding a claim, including reasons based on clinical criteria and coding guidelines. It prohibits downcoding based solely on automated processes without clinical review and requires a physician's final decision on downcoding.