Oregon HB4054 mandates health insurers to notify providers when AI downcodes claims.
Oregon HB4054 requires certain health insurers to inform healthcare providers when they use artificial intelligence or other automated technology to downcode a claim for reimbursement. The bill mandates that insurers notify providers in writing within two business days of the downcoding, detailing the use of AI, the reason for downcoding, and the provider's right to appeal. This applies to health benefit plans in Oregon that conduct or have utilization review provided on their behalf.
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