HB 4054: Relating to downcoding.
Requires certain health insurers offering a health benefit plan in this state that provide utilization review or have utilization review provided on their behalf to notify a health care provider each time the insurer uses artificial intelligence or other automated technology to automatically downcode a claim for reimbursement submitted by the provider. Requires insurers to make an appeals process available to a provider who has had a claim automatically downcoded using artificial intelligence or other automated technology.
Topics
✓ HealthcareSupports HealthcareRequires insurers to notify providers and provide appeals for AI-driven claim downcoding, protecting provider reimbursement rights and ensuring fair billing practices in healthcare insurance.
✓ TechnologySupports TechnologyRequires insurers to notify providers and provide appeals when using AI to downcode claims, ensuring transparency and accountability in AI-driven healthcare billing decisions.





