OR HB4054

Health insurers using artificial intelligence or automated technology to downcode reimbursement claims must notify providers in writing within two business days of payment, including the specific reason for downcoding and applicable appeals process

"Downcoding" is defined as changing a billing code to one with a lower reimbursement rate than the original code submitted by the provider

Insurers must provide an appeals process before a medical consultant or peer review committee for providers whose claims were automatically downcoded, consistent with existing processes under ORS 743B.453

Insurers must post their appeals process for downcoded claims on their website alongside other utilization review requirements

Applies to health benefit plans issued, renewed, or extended on or after the effective date of the 2026 Act