New York S04833 ensures downcoding an insurance claim is recognized as an adverse determination and prohibits health plans from altering medical.
New York S04833 amends the insurance law and public health law to recognize the decision to downcode an insurance claim as an adverse determination. It prohibits health plans from reversing or altering medical necessity determinations made by a utilization review agent or external appeals agent as a result of an audit of claims. This bill aims to protect the integrity of initial medical necessity determinations and ensure that audits do not undermine these decisions.
Included in complete analysis
- Overview
- Core Provisions
- Implementation
- Impact
- Legal Framework
- Critical Issues
Analyze for Free
See what it does, who it affects, and the critical issues in plain language. Free, 30 seconds.