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Hospitals, insurers spar over transparency, penalties in bill targeting automated insurance reviews
Summary
Hospitals told the Financial Institutions and Insurance Committee that automated utilization-management systems appear to drive denials and shift clinician time to appeals; insurers warned the bill’s 20% penalty trigger and requirement of medical-director review for all claims are unworkable and could duplicate recent reforms.
Chairman Bridal convened the Financial Institutions and Insurance Committee and opened discussion on Assembly Bill 3858, which would require insurers to collect data on claims and decisions made using automated utilization-management systems.
Christine Stearns of the New Jersey Hospital Association told the committee that greater transparency is needed because the growing use of automated systems “seems to correlate to an increase in denials and delays for patients.” She said those systems can prioritize cost containment over patient care and that appeals “require a clinician’s time and attention” that pulls staff away from direct patient care and…
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