HB4735

Transparency in Downcoding Act mandates transparency and fairness in health insurance downcoding practices.

The Transparency in Downcoding Act aims to ensure transparency and fairness in health insurance downcoding practices. It prohibits health insurance issuers from using automated processes to downcode claims, downcoding based solely on diagnosis codes, and targeting or discriminating against physicians treating patients with complex or chronic conditions. The Act requires issuers to provide detailed notifications for downcoded claims, including clinical criteria, service codes, and physician credentials.