FL S1130

Prohibits insurance payment adjudicators from downcoding health care services billed by in-network providers unless expressly permitted in the participation agreement, and requires medical record review before any permitted downcoding

Requires utilization review entities to establish electronic prior authorization processes, make determinations within 72 hours for non-urgent services and 24 hours for urgent services, and prohibits prior authorization requirements for emergency services and opioid use disorder medications

Reduces timeframes for health insurers to pay or contest electronic claims from 20 days to 15 days, and establishes that claims must be paid within 90 days or become uncontestable obligations

Increases the interest rate on overdue claim payments from 12% to 15% per year, calculated on the full amount that should have been paid, and shortens the timeframe for denying claims due to insured ineligibility from 1 year to 90 days

Creates private causes of action for health care providers to sue health insurers for violations of downcoding restrictions, prior authorization requirements, and prompt payment provisions