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Committee hears proposal to require disclosure when AI alters health billing codes
Summary
Committee members discussed drafting a concept to require insurers to disclose if automated systems (AI) altered provider-submitted billing codes, after members reported instances of claims being "downcoded" without provider notice and raised concerns about appealability and transparency.
Representative Aaron Nathanson and committee staff described reports from health care providers that insurers may be using automated tools to alter submitted billing codes — a practice described in the meeting as "downcoding" — without notifying the provider. "I wrote this, but it was changed into something else… The claim was just changed, changed by not a human, changed…
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