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

This bill (SF 2226) requires health insurance carriers in Iowa to use human clinical reviewers before automatically denying or downcoding claims submitted by health care providers. It mandates detailed written notices to providers explaining any automated denial or downcode, including the reason, policy justification, and appeal rights (with 30 days to appeal). Health carriers must also disclose their automated system use and oversight processes to the insurance commissioner and maintain documentation for five years. The law applies directly to health carriers (insurance companies, HMOs, etc.) and affects health care providers who submit claims for reimbursement.