Reconsideration of a Health Plan's Policy Regarding Code Edits

Outlines practices to be followed:

  • by provider organizations when requesting a health plan to reconsider their policy about a specific code edit and
  • by health plans when processing and responding to those requests. (Note: This BPR is related to policy changes and not specific claims)
BPR Category
Claims Edits
Legislation page
Legislative Section
Section 9 (1)(e)