Relating to the use of extrapolation by a health maintenance organization or an insurer to audit claims.

SB 1811 prohibits health insurers and health maintenance organizations (HMOs) from using mathematical estimation ("extrapolation") to audit claims for participating physicians or providers. Instead, any payment adjustments must be based solely on actual reviewed claims, not estimates of unreviewed claims. The law applies only to contracts entered into or renewed on or after September 1, 2025, and does not affect Medicaid or child health programs. This change directly affects private insurers, HMOs, and healthcare providers who receive payments under their contracts.