Prohibits automatic downcoding of health claims by insurers and requires clinical review.
The Transparency in Downcoding Amendment Act of 2026 amends the Prompt Pay Act of 2002 to prohibit health insurers from automatically downcoding claims using automated processes, including artificial intelligence, or based solely on diagnosis codes. It mandates that all downcoding decisions be made by licensed clinicians in the District of Columbia. Insurers must notify clinicians of downcoded claims, providing specific reasons and codes.
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