265.965           Physician Appeal’s Mechanisms for Down Coded or Denied Claims:

265.965           Physician Appeal’s Mechanisms for Down Coded or Denied Claims:

MSSNY will seek legislation and/or regulation to ensure that physicians have an appropriate appeals mechanism which third party payors should make available to physicians when claims have been denied or “down coded” by such payors.  Such legislation and/or regulation should require (a) all payors to notify the physicians of the appropriate appeals mechanism to be utilized when a claim is denied or “down coded” and (b) all third party payors to provide physicians with a clear and accurate explanation on all claims that have been denied or “down coded”.  (HOD 2000-66; Reaffirmed HOD 2014; Reaffirmed HOD 2024)