Modifications to Procedure Codes on Health Insurance Claims and Payment of Claims

DIVISION OF INSURANCE Frank H. Murkowski, Governor 550 W. 7th Avenue, Suite 1560, Anchorage, Alaska 99501-3567 Telephone: (907) 269-7900 Fax: (907) 269-7910 Text Telephone: (907) 465-5437 E-mail: insurance@commerce.state.ak.us Website: http://www.commerce.state.ak.us/insurance/ BULLETIN B 05-10 TO: HEALTH CARE INSURERS AND LICENSEES TRANSACTING HEALTH CARE INSURANCE IN ALASKA AND OTHER INTERESTED PARTIES RE: MODIFICATIONS TO PROCEDURE CODES ON HEALTH INSURANCE CLAIMS AND PAYMENT OF CLAIMS It has come to the attention of the Division of Insurance that some insurers are unilaterally changing procedure codes on certain health insurance claims in order to determine allowable charges and payment on these claims. The division recognizes that health care providers may make errors in listing coding procedures on a claim for payment and that an insurer needs to correct the code before determining allowable charges and paying a claim. The division considers the practice of changing procedure codes without consultation with and the concurrence of the health care provider who provided the service or supply a violation of Alaska's unfair claim settlement practice laws under AS 21.36.125. An insurer that is found to have changed a procedure code without consultation with and the concurrence of the health care provider who provided the service or supply may be subject to administrative action by the division. Dated this 16th day of November, 2005 at Anchorage, Alaska. Linda S. Hall Director