HB 2407

Summary

As introduced: - Prohibits a health insurer from using an automated process to make a final decision to downcode a claim, instead requiring a documented review by a health care professional of the same specialty. - Establishes procedural rights for providers when a claim is downcoded, including specific notification requirements and a clear process for appeals. - Allows a health care provider to appeal substantially similar downcoding issues in batches without restriction. - Prohibits a health insurer from using downcoding practices in a targeted or discriminatory manner against a provider who treats patients with complex or chronic conditions. - Authorizes a civil penalty of up to $100 per violation for improper downcoding and allows for other enforcement actions for a pattern of discriminatory downcoding.

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