FL H1015

Prohibits health insurers from downcoding (reducing billing codes to pay less) health care services ordered by in-network providers unless expressly permitted in participation agreements, and requires medical record review before any downcoding occurs

Requires utilization review entities to establish electronic prior authorization systems and respond to non-urgent authorization requests within 72 hours and urgent requests within 24 hours; prohibits prior authorization for emergency services and opioid use disorder medications

Shortens claims payment deadlines to 15 days for electronic claims and 30 days for paper claims (down from 20 and 40 days), and increases interest rate on overdue payments from 12% to 15% annually

Reduces the timeframe for insurers to request overpayments from providers from 30 months to 18 months, and limits retrospective claim denials for enrollee ineligibility to 90 days (down from 1 year)

Creates private causes of action allowing health care providers to sue insurers for violations of downcoding restrictions, prior authorization requirements, and prompt payment rules; takes effect July 1, 2026