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.

Statutes affected:
A3707: 3224-a insurance law, 3224-a(i) insurance law, 4900 insurance law, 4900(a) insurance law, 4900 public health law, 4900(1) public health law