SF 2226

As introduced: - Prohibits a health carrier from using an automated adjudication system to deny or downcode a health care claim without a prior, individualized review by a clinical reviewer. - Requires a health carrier to provide written notice to a health care provider of a proposed claim denial or downcode and establishes a process for the provider to appeal the decision. - Mandates that health carriers disclose information about their automated adjudication systems to the commissioner of insurance, including the criteria used and oversight processes. - Establishes civil penalties of up to $10,000 per violation and creates a private right of action for providers or other injured persons against a health carrier for violations.