CT SB00405

Prohibits insurers, health care centers, hospital service corporations, medical service corporations, preferred provider networks, and other entities from downcoding health benefit claims submitted by health care providers effective July 1, 2025.

Defines "downcoding" as adjusting a health benefit claim to a less complex or lower cost billing code to provide lower reimbursement than required for the actual service performed under the contract.

Applies the prohibition to all contracts entered into, renewed, or amended on or after July 1, 2025, that provide health benefits to insureds or enrollees in Connecticut.

Specifies that downcoding includes but is not limited to the use of remark codes.

Directs the Insurance Commissioner to adopt regulations in accordance with chapter 54 of the general statutes to implement the provisions.