If an insurance carrier does NOT reconsider a downcoded claim that has been appealed, the medical office specialist can:
A) request assistance from the state insurance commissioner.
B) file a complaint with the Department of Health and Human Services (DHHS).
C) file a complaint with the Centers for Medicare and Medicaid Services (CMS).
D) bill the patient for the remaining balance.

Question

Quizplus · Accepted Answer

Requesting assistance from the state insurance commissioner is a viable option when an insurance carrier does not reconsider a downcoded claim that has been appealed. The state insurance commissioner oversees insurance operations and can intervene in disputes between insurance carriers and policyholders or medical providers.

If an Insurance Carrier Does NOT Reconsider a Downcoded Claim