Protecting Patients from Automated Denials Act restricts use of artificial intelligence in Medicare Advantage prior authorization denials.

The Protecting Patients from Automated Denials Act amends title XVIII of the Social Security Act to establish requirements for the use of artificial intelligence in prior authorization denials by Medicare Advantage organizations. It prohibits Medicare Advantage plans from denying requests for prior authorization based solely on the output of artificial intelligence unless specific conditions are met. These conditions include a review and approval by a qualified physician reviewer, who must provide a signed attestation that the denial was not generated or dictated by artificial intelligence.

Protecting Patients from Automated Denials Act restricts use of artificial intelligence in Medicare Advantage prior authorization denials.

The Protecting Patients from Automated Denials Act amends title XVIII of the Social Security Act to establish requirements for the use of artificial intelligence in prior authorization denials by Medicare Advantage organizations. It prohibits Medicare Advantage plans from denying requests for prior authorization based solely on the output of artificial intelligence unless specific conditions are met. These conditions include a review and approval by a qualified physician reviewer, who must provide a signed attestation that the denial was not generated or dictated by artificial intelligence.