If a claim is downcoded, the insurer shall:

1. (1) notify the provider using the appropriate CARC and RARC to clearly indicate that the claim has been downcoded; and

2. (2) provide:

   1. (A) the specific reason for the downcoding, including reference to the clinical criteria used to justify the downcoding;
   2. (B) the original and revised service codes and payment amounts; and
   3. (C) a notice of the right to appeal as described in section 12 of this chapter.

As added by P.L.88-2026, SEC.6.