1. (a) An insurer may not use an automated:

   1. (1) process;
   2. (2) system; or

   3. (3) tool, including artificial intelligence;

      as the sole basis to downcode a claim based on medical necessity without the review of the covered individual's medical record by an employee or contractor of the insurer.

2. (b) A provider may not use an automated:

   1. (1) process;
   2. (2) system; or

   3. (3) tool, including artificial intelligence;

      to submit a health benefits claim without the review of a provider or other person involved in the development of the claim for submission.

3. (c) An insurer must disclose in an easily accessible and readable manner when artificial intelligence is used to:

   1. (1) make an adverse determination on a prior authorization request; or
   2. (2) downcode a claim.

As added by P.L.88-2026, SEC.6.