HB4054 OR failed

Relating to downcoding.

privacy

Plain-English summary

**ONE-SENTENCE SUMMARY:** This bill aimed to require health insurers to notify providers when they use AI to downcode claims for reimbursement.

**KEY REQUIREMENTS:**
   - Health insurers must inform healthcare providers whenever AI or automated technology is used to downcode a claim.
   - Insurers must provide an appeals process for providers affected by downcoding.

**DEADLINES:** The bill has failed, so there are no effective dates or compliance deadlines to worry about.

**PENALTIES:** Since the bill did not pass, there are no fines or enforcement mechanisms associated with it.

**SMB IMPACT:** Small healthcare providers would have benefited from transparency in the claims process and a clear appeals process for downcoded claims, but since the bill failed, they remain without these protections.

Source description

Tells some health insurers to inform health care providers when they use AI to downcode a claim for reimbursement. (Flesch Readability Score: 62.8). 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.

Not legal advice. Summaries are generated by AI from publicly available bill text and may contain errors or omissions. Always consult counsel before making compliance decisions.