SC S0920

Requires health insurers using artificial intelligence for prior authorization decisions to base determinations on the enrollee's individual medical history, unique clinical circumstances, and information from their medical record rather than relying solely on group datasets

Mandates that any decision to deny, reduce, or defer a prior authorization request must be made by a licensed physician or qualified healthcare professional who can evaluate the AI's recommendation against the patient's specific clinical circumstances

Requires insurers to provide prominent written disclosure to enrollees when AI, algorithms, or other software tools are used in utilization review processes

Obligates insurers to certify annually to the Department of Insurance that their AI tools are applied fairly, do not discriminate, and are periodically reviewed for accuracy and reliability

Authorizes the Department of Insurance to investigate violations, hold hearings, impose corrective plans, and apply disciplinary measures under Section 38-71-90 for repeat offenders