IN HB1271

HB 1271 Summary: Payment of Health Claims

• Hospitals must provide written notice of payment assistance programs (charity care, financial assistance, payment plans) to patients during registration, at discharge, or with the initial billing statement, and post signage in registration areas and emergency departments.

• Insurers are prohibited from using automated systems or AI as the sole basis to downcode claims without human review of medical records, and must disclose when AI is used in adverse determinations or downcoding decisions.

• The timeframe for insurers to request overpayment repayment or recoup paid claims is reduced from 2 years to 180 days; retroactive audits of paid claims are limited to 3 years.

• Insurers cannot retroactively reduce reimbursement rates for CPT codes and must provide at least 60 days written notice before implementing prospective rate reductions.

• Providers have at least 180 days to appeal downcoded claims, may appeal batches of similar claims, and have 90 days to resubmit claims to the correct insurer following recoupment due to coordination of benefits errors.