TO AMEND THE HEALTHCARE CONTRACTING SIMPLIFICATION ACT; TO DEFINE "DOWNCODE" UNDER THE HEALTHCARE CONTRACTING SIMPLIFICATION ACT; AND TO REQUIRE NOTIFICATION BY CONTRACTING ENTITIES OF DOWNCODING.

HB 1287 amends the Healthcare Contracting Simplification Act to define "downcode" (when insurers or payers reduce payment amounts below what a healthcare provider billed) and requires all healthcare payers to notify providers when they downcode a claim. This directly affects hospitals, clinics, and healthcare providers who receive payments from insurance companies or government programs like Medicaid. The key provision mandates clear, timely written notice to providers whenever a payment is downcoded, ensuring transparency about reduced reimbursements. The law aims to simplify billing disputes by establishing a clear definition and notification requirement, reducing confusion over payment adjustments.