Health insurance; ethics and fairness in carrier business practices, downcoded claims.

Health insurance; ethics and fairness in carrier business practices; downcoded claims. Prohibits a carrier, intermediary, administrator, or representative of a carrier from downcoding a claim unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination. The bill requires a carrier, intermediary, administrator, or representative that downcodes a cl…

Source: OpenStates · fetched April 13, 2026

• W-2 worker (non-union)indirectModerate impactHigh certainty

  Ensures that claims submitted by healthcare providers are not unfairly downcoded by insurance carriers, which could lead to reduced reimbursement and potentially impact the cost or availability of healthcare services for patients.

  “Prohibits a carrier, intermediary, administrator, or representative of a carrier from downcoding a claim unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination.”· Health insurance; ethics and fairness in carrier business practices; downcoded claims.

• Medicaid / public insuranceindirectModerate impactHigh certainty

  Applies to health insurance carriers, potentially affecting how Medicaid claims are processed and reimbursed, ensuring fairness in downcoding practices.

  “Prohibits a carrier, intermediary, administrator, or representative of a carrier from downcoding a claim unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination.”· Health insurance; ethics and fairness in carrier business practices; downcoded claims.