However, doctors should take HMOs to small claims court only if they are confident that the claims are documented correctly and that the patient records can substantiate the claim, Knight said. Back to top. Here's what experts say you should do to protect yourself from insurers downcoding your claims. In all of these steps, it's important to keep thorough records. Review any contract before you sign it.
Most contracts spell out reasons for downcoding and what the physician can expect during an appeal.
Make sure you've filled out the claim correctly. If a claim comes back, call claims administration and check to see if more documentation is necessary. If you've done everything right and the claim is still downcoded, contact the insurer's medical director or regional director. Avoid fighting with low-level administrators. If informal discussions with a director don't work, file an internal appeal.