What is an insurance downgrade?

This is when an insurance company automatically changes the CPT code from the code you billed and submitted from Luminello, to a code it believes is more appropriate. For example, if you bill a 99205 for an intake session, but the patient/client has previously had that billing code used within a certain timeframe, the insurance company may downgrade it to a 99215.

Please note, neither Luminello nor ApexEDI have any control over this. To remedy this, you must contact the insurance company directly.

That's it! If you have any questions, please contact us.