Appeal process

Sec. 12. (a) An insurer shall provide providers with a clear and accessible process for appealing downcoded claims, including: (1) a written or electronic notice detailing how to initiate an appeal; (2) contact information for the individual managing the appeal; and (3) a timeline for submission of an appeal that is not less than one hundred eighty (180) days. (b) An insurer shall allow a provider to appeal in batches of similar claims involving substantially similar downcoding issues without restriction. As added by P.L.88-2026, SEC.6.