IL SB3114

Prohibits health insurance issuers from using automated processes, artificial intelligence, or other automated tools to downcode medical claims, requiring instead that downcoding decisions be made by a licensed physician of the same or similar specialty

Requires insurers to notify physicians of downcoded claims with specific reasons, clinical criteria used, original and revised payment amounts, and the reviewing physician's credentials and National Provider Identifier

Establishes an appeal process allowing physicians at least 180 days to challenge downcoded claims, including the right to appeal batches of similar claims, with appeals reviewed by a qualified physician not involved in the original decision

Bans downcoding based solely on diagnosis codes and prohibits discriminatory downcoding practices targeting physicians who treat patients with complex or chronic conditions

Authorizes the Department of Insurance to enforce violations with penalties up to $50,000 per violation, orders to reprocess claims with interest, and potential license suspension for patterns of discriminatory downcoding