HB 4054
Requires certain health insurers offering a health benefit plan in this state that provide utilization review or have utilization review provided on their behalf to notify a health care provider each time the insurer uses artificial intelligence or other automated technology to automatically downcode a claim for reimbursement submitted by the provider.
Jurisdiction
Oregon
Session
2026 Regular Session
At the request of
(at the request of Joint Legislative Committee on Information Management and Technology for Representative Nancy Nathanson)
Committee
Information Management and Technology
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Sign in to take actionPublic sentiment
Support
93%
Oppose
7%
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill requires health insurers that use artificial intelligence or other automated technology to downcode claims for reimbursement to notify the healthcare provider each time this happens. It also mandates that insurers provide an appeals process for providers who believe their claims were incorrectly downcoded due to AI. The bill aims to increase transparency and accountability in how insurers utilize automated systems for claim processing.
Sponsors
Official sponsors from legislative records.
Primary sponsor
Cosponsor
Joint Legislative Committee on Information Management and Technology
Arguments in favor
Reasons to support this legislation.
Supporters of the measure advocate for increased transparency in AI-driven downcoding practices by insurers, citing concerns about inaccurate billing and revenue loss for healthcare providers. They argue that lack of transparency undermines fair process, protects physicians' legal and ethical duty to treat every patient without reevaluation, and can lead to reduced payments for care already provided without notice or explanation. The bill aims to address these issues by requiring insurers to disclose their downcoding practices, promoting clearer insight into claims review processes, and reducing administrative burdens on clinics, thereby supporting the efficient operation of healthcare clinics and reducing potential errors or overpayments.
Source: Testimony Summaries
Arguments opposed
Reasons to oppose this legislation.
Opponents of House Bill 4054 express concerns that the proposed legislation could disrupt existing utilization review processes and hinder the development of evidence-based criteria. Regence specifically notes that creating Oregon-specific requirements could undermine interoperability with other healthcare systems, potentially increasing member premiums. Additionally, proponents of HB 4054 are urged to engage in collaborative efforts to develop a concept that balances their goals with the need for state-specific rules, rather than introducing new, rigid requirements that may not be effective or efficient.
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