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A06937 Summary:

BILL NOA06937
 
SAME ASNo Same As
 
SPONSORWeprin
 
COSPNSR
 
MLTSPNSR
 
Amd 3224-b, 3224-a & 4900, Ins L; amd 4900, Pub Health L
 
Ensures the decision to downcode an insurance claim is recognized as an adverse determination; 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.
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