New Jersey A238 prohibits downcoding in health insurance claims to ensure providers are reimbursed for actual services performed.

New Jersey A238 prohibits health insurance payers from using downcoding, which is the practice of adjusting claims to a less complex or lower cost service to reduce reimbursement. This ensures health care providers can submit claims for the actual service performed and collect appropriate reimbursement. The bill applies to health insurance carriers, organized delivery systems, or any agents doing business in New Jersey. The Department of Banking and Insurance will adopt regulations to implement this prohibition.

New Jersey A238 prohibits downcoding in health insurance claims to ensure providers are reimbursed for actual services performed.

New Jersey A238 prohibits health insurance payers from using downcoding, which is the practice of adjusting claims to a less complex or lower cost service to reduce reimbursement. This ensures health care providers can submit claims for the actual service performed and collect appropriate reimbursement. The bill applies to health insurance carriers, organized delivery systems, or any agents doing business in New Jersey. The Department of Banking and Insurance will adopt regulations to implement this prohibition.