TRANSPARENCY IN DOWNCODING ACT

Summary

The Transparency in Downcoding Act bars insurers from using algorithms or diagnosis‑only reasons to lower claim payments and mandates that any downcoding decision be made by a qualified physician. It applies to most health‑insurance policies issued or renewed after the law takes effect, except self‑insured ERISA plans and workers‑comp coverage, and creates notification, appeal and enforcement rules to protect providers and patients.

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