A bill for an act relating to the use of automated adjudication systems by health carriers, and including civil penalties.

Summary

The bill bars health carriers from using automated adjudication systems to deny or lower the payment of a claim unless a clinical reviewer first examines the claim and supporting documentation. It also obligates insurers to give providers written notice of any proposed downcode or denial, allow a 30‑day appeal period, and submit annual reports. Violations can be punished with civil penalties.

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