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IA SF2226
Bill
AI Summary
- Health carriers are prohibited from using automated adjudication systems (including AI, algorithms, and machine-learning) to downcode or deny claims without first conducting a documented individualized review by a human clinical reviewer
- Before finalizing any downcode or denial, carriers must provide written notice to healthcare providers including the original code, proposed adjustment, clinical justification, identity of the reviewer, and appeal rights
- Healthcare providers must receive at least 30 calendar days to appeal or submit additional documentation before a downcode or denial is finalized
- Civil penalties of up to $10,000 per violation may be imposed by the Insurance Commissioner, with violations affecting multiple claims potentially treated as separate offenses
- The bill creates new Chapter 514M in Iowa Code, applying to insurance companies, health maintenance organizations, nonprofit health service corporations, and public employee health plans
Legislative Description
A bill for an act relating to the use of automated adjudication systems by health carriers, and including civil penalties.
Last Action
Subcommittee: Warme, Petersen, and Schultz. S.J. 244.
2/10/2026
Committee Referrals
Commerce2/5/2026
Full Bill Text
No bill text available