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New York policy

A3707: Relates to downcoding on initial review and audits reversing or altering medical necessity determinations

NY Assembly · Sponsor David Weprin

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Jurisdiction
New York State
Applies to
New York State (proposed)
Effective
January 7, 2026

What it requires

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.

ny-stateassemblylegislationbill

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