(at the request of Joint Legislative Committee on Information Management and Technology for Representative Nancy Nathanson)
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Bill Title:
Relating to downcoding.
Catchline/Summary:
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. Digest: 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.
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