VA HB484

Requires health insurance carriers to have downcoding decisions (reducing reimbursement codes on claims) made by a natural person or electronic system that reflects correct coding standards and considers all relevant patient data, with providers receiving at least 180 days to dispute downcoded claims

Mandates carriers implement a prior authorization application program interface (API) by January 1, 2027, consistent with federal Centers for Medicare and Medicaid Services requirements, to streamline electronic processing of prior authorization requests

Requires healthcare providers to ensure their electronic health record systems can access the carrier's prior authorization API within one year of the carrier's implementation deadline, with hardship waivers available

Establishes that carriers must post annual prior authorization data on their websites by March 31 each year, including metrics required by federal CMS regulations

Creates a work group coordinated by the Bureau of Insurance and Secretary of Health and Human Resources to monitor electronic prior authorization implementation and consider expanding prior authorization metrics reporting to include prescription drugs, with final report due November 1, 2028