Maryland SB797 regulates downcoding of health insurance claims, requiring insurers to follow specific procedures and prohibiting certain practices.
Maryland SB797 amends the Maryland Medical Assistance Program and Health Insurance laws to regulate the downcoding of health insurance claims. Insurers, nonprofit health service plans, and health maintenance organizations must follow specific procedures when downcoding claims, including providing notice to health care providers and allowing them to respond. The bill prohibits downcoding based solely on diagnosis codes, targeting specific providers, or using automated tools without clinical review. Insurers must report downcoding data to the Commissioner and face penalties for violations.
Included in complete analysis
- Overview
- Core Provisions
- Implementation
- Impact
- Legal Framework
- Critical Issues
See what it does, who it affects, and the critical issues in plain language. Free, 30 seconds.