Illinois SB3114 establishes transparency and fairness in downcoding practices by health insurance issuers.
The Transparency in Downcoding Act aims to ensure fair and transparent practices in downcoding by health insurance issuers. It prohibits downcoding based solely on diagnosis codes, using automated processes, or targeting physicians treating patients with chronic conditions. The act mandates that downcoding decisions be made by a physician with relevant expertise and requires clear notification to physicians when claims are downcoded. It also establishes an appeal process for physicians to contest downcoded claims, ensuring that appeals are reviewed by an independent physician.
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- Overview
- Core Provisions
- Implementation
- Impact
- Legal Framework
- Critical Issues
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