AN ACT PROHIBITING HEALTH INSURERS FROM USING SOFTWARE TOOLS TO AUTOMATICALLY DOWNCODE HEALTH INSURANCE CLAIMS.

SB 817 prohibits health insurers from using software tools - including artificial intelligence or algorithms - to automatically downcode or deny claims submitted by healthcare providers. This directly affects health insurers and healthcare providers, as it requires insurers to conduct a detailed clinical peer review before adjusting or rejecting any claim. The bill mandates that insurers cannot rely on automated systems for these decisions, ensuring human clinical review is required for all claim adjustments. The law aims to prevent arbitrary claim denials or downcoding without proper medical evaluation.