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LEGISLATURE
OF
THE
STATE
OF
IDAHO
Sixty-eighth
Legislature
Second
Regular
Session
-
2026
IN
THE
HOUSE
OF
REPRESENTATIVES
HOUSE
BILL
NO.
829
BY
HEALTH
AND
WELFARE
COMMITTEE
AN
ACT
1
RELATING
TO
PROMPT
PAYMENT
OF
CLAIMS;
AMENDING
SECTION
41
-
5601,
IDAHO
CODE,
2
TO
DEFINE
TERMS;
AMENDING
SECTION
41
-
5602,
IDAHO
CODE,
TO
REVISE
PRO
-
3
VISIONS
REGARDING
PROMPT
PAYMENT
OF
CLAIMS;
AMENDING
SECTION
41
-
5603,
4
IDAHO
CODE,
TO
REVISE
PROVISIONS
REGARDING
INTEREST
PAYMENTS;
AMEND
-
5
ING
SECTION
41
-
5605,
IDAHO
CODE,
TO
REVISE
PROVISIONS
REGARDING
EXCEP
-
6
TIONS;
AMENDING
SECTION
41
-
5606,
IDAHO
CODE,
TO
REVISE
PROVISIONS
RE
-
7
GARDING
PENALTIES;
AMENDING
CHAPTER
56,
TITLE
41,
IDAHO
CODE,
BY
THE
AD
-
8
DITION
OF
A
NEW
SECTION
41
-
5607,
IDAHO
CODE,
TO
ESTABLISH
PROVISIONS
RE
-
9
GARDING
CIVIL
ACTIONS
AND
PROHIBITED
RETALIATORY
CONDUCT
BY
INSURERS;
10
AMENDING
CHAPTER
56,
TITLE
41,
IDAHO
CODE,
BY
THE
ADDITION
OF
A
NEW
SEC
-
1
1
TION
41
-
5608,
IDAHO
CODE,
TO
ESTABLISH
PROVISIONS
REGARDING
CONTRACT
-
12
ING
STANDARDS
AND
APPLICABILITY;
AMENDING
CHAPTER
56,
TITLE
41,
IDAHO
13
CODE,
BY
THE
ADDITION
OF
A
NEW
SECTION
41
-
5609,
IDAHO
CODE,
TO
ESTABLISH
14
PROVISIONS
REGARDING
TRANSPARENCY
REQUIREMENTS;
AND
DECLARING
AN
EMER
-
15
GENCY
AND
PROVIDING
AN
EFFECTIVE
DATE.
16
Be
It
Enacted
by
the
Legislature
of
the
State
of
Idaho:
17
SECTION
1.
That
Section
41
-
5601,
Idaho
Code,
be,
and
the
same
is
hereby
18
amended
to
read
as
follows:
19
41
-
5601.
DEFINITIONS.
As
used
in
this
chapter:
20
(1)
"Beneficiary"
means
a
policyholder,
subscriber,
member,
employer
21
or
other
person
who
is
eligible
for
benefits
under
a
contract
providing
hos
-
22
pital,
surgical,
or
medical
expense
coverage
or
a
managed
care
organization
23
policy
or
agreement
under
which
a
third
party
payer
agrees
to
reimburse
for
24
covered
health
care
services
rendered
to
beneficiaries
in
accordance
with
25
the
benefits
contract.
26
(2)
"Claim"
means
a
request
from
a
beneficiary
or
a
practitioner
or
fa
-
27
cility
for
payment
for
covered
health
care
services
submitted
to
an
insurer.
28
A
claim
is
presumed
to
be
a
complete
claim
unless
the
insurer
provides
timely
29
notice
in
accordance
with
the
provisions
of
section
41
-
5602(4),
Idaho
Code.
30
(3)(a)
"Complete
claim"
means
a
claim
that:
31
(i)
Has
no
material
defect
or
impropriety;
32
(ii)
Includes
all
information
reasonably
required
by
the
insurer
33
to
adjudicate
the
claim;
34
(iii)
Requires
no
additional
information
from
a
third
party
that
35
is
reasonably
necessary
to
adjudicate
the
claim;
and
36
(iv)
Complies
with
the
insurer's
published
claim
-
submission
37
standards
in
effect
at
the
time
the
claim
is
submitted.
38
(b)
A
claim
shall
not
fail
to
meet
the
definition
of
complete
claim
due
39
to
minor
clerical
or
technical
errors
or
because
an
insurer
requests
in
-
40
formation
or
documentation
that
is
not
reasonably
necessary
to
adjudi
-
41
cate
the
claim.
42
2
(2)
(4)
"Date
of
payment"
means
the
date
the
payment
is
sent
as
indi
-
1
cated
by
the
mail
stamp
on
the
envelope,
by
the
insurer
to
the
practitioner
or
2
facility
or
to
the
beneficiary
in
the
event
there
is
not
a
contract
for
direct
3
payment
by
the
insurer
to
the
practitioner
or
facility,
or,
in
the
event
of
4
a
wire
or
other
electronic
funds
transfer,
upon
acceptance
by
the
insurer's
5
bank
of
a
payment
order.
6
(3)
(5)
"Department"
means
the
department
of
insurance.
7
(4)
(6)
"Director"
means
the
director
of
the
department
of
insurance.
8
(5)
(7)
"Electronic
claim"
means
a
claim
that
is
transmitted
through
9
the
use
of
electronic
media,
which
includes
the
internet,
extranet,
leased
10
lines,
dial
-
up
lines,
private
networks,
and
those
transmissions
that
are
1
1
physically
moved
from
one
(1)
location
to
another
using
magnetic
tape,
disk
12
or
compact
disk
media.
The
claim
shall
contain
the
proper
format
and
code
13
sets
in
accordance
with
the
applicable
implementation
specifications
under
14
45
CFR
160
et
seq.,
and
45
CFR
162
et
seq
submitted
to
a
health
insurer
through
15
secure
electronic
data
exchange
in
a
standardized,
HIPAA
-
compliant
format,
16
including
the
ASC
X12N
837
transaction,
and
that
contains
all
data
necessary
17
for
adjudication.
Electronic
claims
shall
not
include
paper,
faxed,
or
18
scanned
submissions
.
19
(6)
(8)
"Insurer"
means
any
insurer
that
sells
hospital,
medical,
long
-
20
term
care,
or
vision
insurance
policies
or
certificates
and
managed
care
or
-
21
ganizations.
For
the
purpose
of
this
chapter
only,
"insurer"
also
includes
a
22
third
party
administrator
who
makes
payments
to
beneficiaries,
practition
-
23
ers
or
facilities
on
behalf
of
an
insurer
and
a
hospital
or
professional
ser
-
24
vice
corporation
that
provides
hospital,
medical,
long
-
term
care
or
vision
25
health
care
services.
26
(7)
(9)
"Practitioner
or
facility"
means
any
physician,
hospital
or
27
other
person
or
facility
licensed
or
otherwise
authorized
to
furnish
health
28
care
services.
29
(8)
(10)
"Receipt
of
claim"
means
the
date
the
claim
is
actually
re
-
30
ceived
by
the
insurer
from
the
practitioner
or
facility
or
the
beneficiary.
31
(9)
(11)
"Submission
of
claim"
means
the
date
the
claim
is
sent
as
indi
-
32
cated
by
the
mail
stamp
on
the
envelope,
by
the
beneficiary,
practitioner
or
33
facility,
to
the
insurer
or
the
date
an
electronic
claim
is
transmitted
to
an
34
insurer.
35
SECTION
2.
That
Section
41
-
5602,
Idaho
Code,
be,
and
the
same
is
hereby
36
amended
to
read
as
follows:
37
41
-
5602.
PROMPT
PAYMENT
OF
CLAIMS.
(1)
Except
as
otherwise
specifi
-
38
cally
provided
in
this
chapter,
an
insurer
shall
process
a
claim
for
payment
39
for
health
care
services
rendered
by
a
practitioner
or
facility
to
a
benefi
-
40
ciary
in
accordance
with
this
section.
41
(2)
If
Except
as
provided
in
subsection
(4)
of
this
section,
if
a
bene
-
42
ficiary,
practitioner
or
facility
submits
an
electronic
claim
to
an
insurer
43
within
thirty
(30)
days
of
the
date
on
which
service
was
delivered,
an
,
the
44
insurer
shall
pay
or
deny
the
claim
not
later
than
thirty
(30)
days
after
re
-
45
ceipt
of
the
claim.
46
(3)
If
Except
as
provided
in
subsection
(4)
of
this
section,
if
a
ben
-
47
eficiary,
practitioner
or
facility
submits
a
paper
claim
for
payment
to
an
48
insurer
within
forty
-
five
(45)
days
of
the
date
on
which
service
was
deliv
-
49
3
ered,
an
,
the
insurer
shall
pay
or
deny
the
claim
not
later
than
forty
-
five
1
(45)
days
after
receipt
of
the
claim.
2
(4)
If
an
insurer
denies
the
a
claim
or
needs
additional
information
3
to
process
the
a
claim,
the
insurer
shall
notify
the
practitioner
or
fa
-
4
cility
and
the
beneficiary
in
writing
within
thirty
(30)
days
of
receipt
5
of
an
electronic
claim
or
within
forty
-
five
(45)
days
of
receipt
of
a
paper
6
claim.
The
notice
shall
state
why
the
insurer
denied
the
claim.
Such
notice
7
shall
specify
all
known
deficiencies
reasonably
identifiable
at
the
time
8
of
notice,
including
all
defects,
omissions,
or
additional
information
and
9
supporting
documentation
required.
Every
effort
shall
be
made
to
inform
10
the
beneficiary,
practitioner,
or
facility
of
any
necessary
information
in
1
1
order
to
adjudicate
the
claim.
An
insurer
shall
make
a
good
faith
effort
12
to
consolidate
all
requests
for
information
to
the
extent
practicable
and
13
shall
avoid
making
serial
requests
for
information
in
violation
of
subsec
-
14
tion
(7)
of
this
section.
Upon
receipt
of
the
requested
documentation,
the
15
insurer
shall
have
twenty
-
one
(21)
days
to
pay
the
claim,
deny
the
claim,
or,
16
if
necessary,
request
further
documentation.
Upon
receipt
of
the
further
17
requested
documentation,
the
insurer
shall
have
an
additional
twenty
-
one
18
(21)
days
to
either
adjudicate
and
pay
or
deny
the
claim.
If
after
this
pe
-
19
riod,
the
insurer
has
still
not
paid
or
denied
the
claim,
the
beneficiary,
20
practitioner,
or
facility
shall
have
the
right
to
file
a
complaint
with
the
21
department
of
insurance
and
begin
charging
interest
on
the
claim
pursuant
to
22
the
provisions
of
section
41
-
5603,
Idaho
Code.
23
(5)
If
the
claim
was
denied
because
more
information
was
required
to
24
process
the
claim,
the
notice
shall
specifically
describe
all
information
25
and
supporting
documentation
needed
to
evaluate
the
claim
for
processing.
26
If
the
practitioner
or
facility
submits
the
information
and
documentation
27
identified
by
the
insurer
within
thirty
(30)
days
of
receipt
of
the
written
28
notice,
the
insurer
shall
process
and
pay
the
claim
within
thirty
(30)
days
29
of
receipt
of
the
additional
information
or,
if
appropriate,
deny
the
claim.
30
An
insurer
shall
make
a
good
faith
effort
to
consolidate
all
requests
for
in
-
31
formation
to
the
extent
practicable
and
shall
avoid
making
serial
requests
32
for
information
in
violation
of
subsection
(7)
of
this
section.
33
(6)
An
insurer
may
request
medical
records
or
additional
documentation
34
only
when
such
information
is
reasonably
necessary
to
adjudicate
a
claim,
35
investigate
fraud,
verify
medical
necessity,
coordinate
benefits,
or
comply
36
with
applicable
law.
37
(7)
An
insurer
shall
not
request
information
or
documentation
for
the
38
primary
purpose
of
delaying
payment,
resetting
statutory
time
frames,
or
39
discouraging
submission
of
claims.
40
(8)
A
practitioner
or
facility
shall
submit
claims
in
good
faith,
41
within
applicable
contractual
or
statutory
timely
filing
requirements,
and
42
using
reasonable
diligence
to
include
information
necessary
for
adjudica
-
43
tion.
Failure
to
submit
a
claim
in
good
faith
or
with
reasonable
diligence
44
shall
not
relieve
an
insurer
of
its
obligations
under
this
chapter
unless
45
such
failure
materially
prevents
the
insurer
from
adjudicating
the
claim
and
46
the
insurer
has
complied
with
the
notice
requirements
of
subsection
(4)
of
47
this
section.
48
(6)
(9)
Any
claim
submitted
pursuant
to
this
chapter
shall
use
the
cur
-
49
rent
procedural
terminology
(CPT)
code
in
effect,
as
published
by
the
Ameri
-
50
4
can
medical
association,
the
international
classification
of
diseases(ICD)
1
code
in
effect,
as
published
by
the
United
States
department
of
health
and
2
human
services,
or
the
healthcare
common
procedural
coding
system
(HCPCS)
3
code
in
effect,
as
published
by
the
United
States
centers
for
medicare
and
4
medicaid
services
(CMS).
5
(7)
(10)
This
chapter
shall
not
apply
to
claims
submitted
under
policies
6
or
certificates
of
insurance
for
specific
disease,
hospital
confinement
in
-
7
demnity,
accident
-
only,
credit,
medicare
supplement,
disability
income
in
-
8
surance,
student
health
benefits
only
coverage
issued
as
a
supplement
to
li
-
9
ability
insurance,
worker's
compensation
or
similar
insurance,
automobile
10
medical
payment
insurance
or
nonrenewable
short
-
term
coverage
issued
for
a
1
1
period
of
twelve
(12)
months
or
less.
12
(11)
For
the
purposes
of
this
chapter,
a
third
-
party
administrator
13
shall
be
subject
to
the
same
provisions
that
apply
to
the
insurer,
practi
-
14
tioner,
or
facility
that
the
third
-
party
administrator
has
entered
into
a
15
written
agreement
with.
16
SECTION
3.
That
Section
41
-
5603,
Idaho
Code,
be,
and
the
same
is
hereby
17
amended
to
read
as
follows:
18
41
-
5603.
INTEREST
PAYMENTS.
19
(1)(a)
An
insurer
that
fails
to
pay,
request
additional
information
20
or
documentation
,
or
deny
a
claim
from
a
beneficiary,
practitioner
or
21
facility
within
the
time
periods
established
in
this
chapter
shall
pay
22
interest
at
the
contract
statutory
rate
pursuant
to
section
28
-
22
-
104,
23
Idaho
Code,
on
the
unpaid
amount
of
a
claim
that
is
determined
to
be
due
24
and
owing.
The
interest
shall
accrue
from
the
date
payment
was
due,
25
pursuant
to
the
provisions
of
this
chapter,
until
the
claim
is
paid.
26
Payment
of
any
interest
amount
of
less
than
four
dollars
($4.00)
shall
27
not
be
required.
Insurers
may
add
any
interest
due
to
a
future
payment
28
to
the
beneficiary,
practitioner
or
facility
shall
be
required
to
pay
29
interest
upon
payment
of
the
claim
if
the
director,
after
receiving
a
30
complaint
regarding
noncompliance
with
the
provisions
of
this
chapter,
31
determines
after
investigating
and
reviewing
the
complaint
that:
32
(i)
The
provider
has
acted
in
good
faith
and
attempted
to
provide
33
all
information
requested
by
the
insurer
in
a
timely
manner;
and
34
(ii)
The
insurer
has
not
acted
in
good
faith
and
has
not
been
35
forthcoming
with
all
documentation
necessary
to
pay
or
deny
the
36
claim.
37
(b)
Interest
shall
begin
accruing
from
the
date
a
complaint
is
filed
38
with
the
department
.
39
(2)
Interest
shall
accrue
at
the
following
compounding
annual
rates:
40
(a)
Ten
percent
(10%)
per
annum
for
the
first
one
hundred
eighty
(180)
41
days
after
the
payment
deadline;
and
42
(b)
Fifteen
percent
(15%)
per
annum
for
any
period
after
the
initial
one
43
hundred
eighty
(180)
days
following
the
payment
deadline.
44
(3)
Interest
owed
shall
be
in
addition
to
the
claim
amount
and
may
not
be
45
offset
against
future
payments.
46
SECTION
4.
That
Section
41
-
5605,
Idaho
Code,
be,
and
the
same
is
hereby
47
amended
to
read
as
follows:
48
5
41
-
5605.
EXCEPTIONS.
(1)
The
time
periods
set
forth
in
section
1
41
-
5602,
Idaho
Code,
shall
not
apply
to
claims
that
the
insurer
reasonably
2
believes
involve
fraud
or
misrepresentation
by
the
practitioner
or
facility
3
or
the
beneficiary
or
to
instances
where
the
insurer
has
not
been
provided
4
the
information
necessary
to
evaluate
the
claim
after
notice
has
been
given
5
requesting
additional
information
by
the
insurer
as
required
by
section
6
41
-
5602(5),
Idaho
Code.
7
(2)
The
time
periods
set
forth
in
section
41
-
5602,
Idaho
Code,
shall
8
not
apply
to
claims
that
the
insurer
reasonably
believes
require
medical
9
records,
including
accident
reports,
for
the
purpose
of
investigating
10
whether
a
claim
is
valid
for
subrogation,
or
the
coordination
of
benefits
1
1
payable
by
the
insurer
with
benefits
payable
by
another
insurer
or
payable
12
under
federal
or
state
law.
13
(3)
An
insurer
is
not
required
to
comply
with
the
time
periods
set
forth
14
in
section
41
-
5602,
Idaho
Code,
if
the
insurer
is
in
compliance
with
a
con
-
15
tract
with
the
practitioner
or
facility
which
specifies
different
payment
16
requirements.
Payments
made
within
the
time
periods
set
forth
in
section
17
41
-
5602,
Idaho
Code,
for
the
purpose
of
this
chapter,
shall
be
deemed
to
be
18
made
in
a
reasonable
and
timely
manner.
19
(4)
(3)
An
insurer
is
not
required
to
comply
with
the
periods
set
forth
20
in
section
41
-
5602,
Idaho
Code,
if
the
fee
or
premium
entitling
a
beneficiary
21
to
insurance
benefits
has
not
been
paid
in
full.
22
(5)
(4)
An
insurer
is
not
required
to
comply
with
the
time
periods
set
23
forth
in
section
41
-
5602,
Idaho
Code,
if
failure
to
comply
is
due
to
an
act
of
24
God,
bankruptcy,
an
act
of
a
governmental
authority
responding
to
an
act
of
25
God
or
emergency
or
the
result
of
a
strike,
walkout
or
other
labor
dispute,
or
26
act
of
terrorism.
27
(5)
The
provisions
of
this
chapter
shall
not
apply
to
a
self
-
funded
28
plan,
including
an
employee
welfare
benefit
plan
that
is
self
-
funded
and
29
governed
by
the
federal
employee
retirement
income
security
act
of
1974,
30
except
to
the
extent
that
such
plan
is
insured
by
an
insurer
subject
to
the
31
jurisdiction
of
this
state.
32
SECTION
5.
That
Section
41
-
5606,
Idaho
Code,
be,
and
the
same
is
hereby
33
amended
to
read
as
follows:
34
41
-
5606.
PENALTIES.
(1)
The
director
shall
enforce
the
provisions
of
35
this
chapter
and
shall
review
and,
if
appropriate,
investigate
complaints
36
received
by
the
department
related
to
noncompliance
with
the
provisions
of
37
this
chapter.
38
(2)
If
the
director
determines
an
insurer
has
violated
the
provisions
39
of
this
chapter,
the
director
may
impose
an
administrative
fine
not
to
exceed
40
five
thousand
dollars
($5,000)
based
upon
an
enforcement
action.
:
41
(a)
Five
thousand
dollars
($5,000);
or
42
(b)
Ten
thousand
dollars
($10,000)
for
a
second
or
subsequent
violation
43
if
such
violation
occurs
within
thirty
-
six
(36)
months
of
the
insurer's
44
most
recent
violation.
45
(3)
The
director
shall
not
may
suspend
or
revoke
an
insurer's
certifi
-
46
cate
of
authority
for
repeated
or
persistent
violation
s
of
this
chapter.
47
(4)
No
administrative
penalty
shall
be
imposed
against
an
insurer
un
-
48
der
this
chapter
or
any
other
provision
of
law
for
failure
to
comply
with
49
6
this
chapter
if,
in
the
calendar
year
it
has
paid
ninety
-
five
percent
(95%)
1
or
more
of
all
claims
subject
to
this
chapter
to
or
on
behalf
of
beneficia
-
2
ries
within
the
time
periods
set
forth
in
section
41
-
5602,
Idaho
Code
Prior
3
to
the
imposition
of
any
administrative
fine,
suspension,
or
revocation,
an
4
insurer
shall
be
provided
notice
and
an
opportunity
for
a
hearing
pursuant
to
5
the
provisions
of
chapter
3,
title
41,
Idaho
Code
.
6
(5)
This
section
shall
not
create
a
private
cause
of
action
by
or
on
be
-
7
half
of
a
beneficiary
or
practitioner
or
facility
against
an
insurer.
8
SECTION
6.
That
Chapter
56,
Title
41,
Idaho
Code,
be,
and
the
same
is
9
hereby
amended
by
the
addition
thereto
of
a
NEW
SECTION
,
to
be
known
and
des
-
10
ignated
as
Section
41
-
5607,
Idaho
Code,
and
to
read
as
follows:
1
1
41
-
5607.
CIVIL
ACTIONS
-
-
PROHIBITED
RETALIATORY
CONDUCT
BY
INSUR
-
12
ERS.
(1)
A
practitioner
or
facility
may
commence
a
civil
action
in
a
court
13
of
competent
jurisdiction
against
an
insurer
for
violations
of
the
provi
-
14
sions
of
this
chapter.
If
a
practitioner
or
facility
proves
that
an
insurer
15
violated
the
provisions
of
this
chapter,
such
practitioner
or
facility
is
16
entitled
to
recover:
17
(a)
Injunctive
relief;
18
(b)
Actual
damages;
19
(c)
Accrued
interest;
and
20
(d)
Reasonable
costs
and
attorney's
fees.
21
(2)(a)
An
insurer
shall
not
retaliate
against
a
practitioner
or
facil
-
22
ity
for
the
exercise
of
rights
pursuant
to
this
chapter.
23
(b)
Prohibited
retaliatory
actions
include
reducing
reimbursement,
24
altering
network
status,
increasing
administrative
burdens,
delaying
25
credentialing,
modifying
utilization
criteria,
or
any
other
conduct
26
reasonably
interpretable
as
dissuading
a
practitioner
or
facility
from
27
exercising
statutory
rights.
28
(c)
Retaliation
shall
constitute
an
unfair
claim
-
settlement
practice.
29
SECTION
7.
That
Chapter
56,
Title
41,
Idaho
Code,
be,
and
the
same
is
30
hereby
amended
by
the
addition
thereto
of
a
NEW
SECTION
,
to
be
known
and
des
-
31
ignated
as
Section
41
-
5608,
Idaho
Code,
and
to
read
as
follows:
32
41
-
5608.
CONTRACTING
STANDARDS
-
-
APPLICABILITY
TO
EXISTING
AND
FU
-
33
TURE
CONTRACTS.
34
(1)(a)
All
provider
contracts,
regardless
of
the
date
of
execution
of
35
such
contract,
shall
comply
with
the
provisions
of
this
chapter
for
36
claims
submitted
on
or
after
July
1,
2026.
37
(b)
An
insurer
shall
not
require
renegotiation
of
unrelated
contract
38
terms
as
a
condition
of
implementing
the
provisions
of
this
section.
39
(2)
No
contract
executed
in
this
state
may
waive
the
provisions
of
this
40
chapter.
41
SECTION
8.
That
Chapter
56,
Title
41,
Idaho
Code,
be,
and
the
same
is
42
hereby
amended
by
the
addition
thereto
of
a
NEW
SECTION
,
to
be
known
and
des
-
43
ignated
as
Section
41
-
5609,
Idaho
Code,
and
to
read
as
follows:
44
41
-
5609.
TRANSPARENCY
REQUIREMENTS.
45
7
(1)(a)
An
insurer
that
uses
automated
decision
tools,
algorithms,
ar
-
1
tificial
intelligence,
or
similar
technologies
to
assist
with
claims
2
intake,
review,
adjudication,
payment
determination,
or
denial,
par
-
3
tial
denial,
or
other
adverse
payment
determination
shall
disclose,
in
4
a
standardized
manner,
whether
such
tools
materially
assisted
in
the
5
determination
of
a
claim
submitted
under
this
chapter.
6
(b)
Disclosure
pursuant
to
this
subsection
shall
be
limited
to
the
fact
7
of
use
of
such
tools
and
the
general
function
for
which
they
were
used
8
and
shall
not
require
disclosure
of
proprietary
systems,
algorithms,
9
prompts,
models,
workflows,
thresholds,
scoring
criteria,
or
trade
se
-
10
crets.
1
1
(c)
The
use
of
automated
decision
tools,
algorithms,
artificial
in
-
12
telligence,
or
similar
technologies
shall
not
relieve
an
insurer
of
re
-
13
sponsibility
for
the
accuracy,
timeliness,
and
statutory
compliance
of
14
any
claim
determination
made
under
this
chapter
or
excuse
noncompliance
15
with
any
provision
of
this
chapter.
16
(d)
A
disclosure
made
pursuant
to
this
subsection
shall
not,
by
itself:
17
(i)
Constitute
evidence
of
an
improper
claims
practice;
18
(ii)
Create
a
presumption
that
a
claim
determination
was
incor
-
19
rect,
arbitrary,
or
unlawful;
20
(iii)
Extend
or
toll
any
statutory
time
frames
applicable
under
21
this
chapter;
22
(iv)
Create
a
right
to
appeal;
or
23
(v)
Require
additional
review,
reconsideration,
or
appeal
beyond
24
those
otherwise
provided
by
law.
25
(2)(a)
A
practitioner
or
facility
that
uses
automated
documentation
26
tools,
coding
assistance
tools,
artificial
intelligence,
or
similar
27
technologies
to
assist
with
clinical
dictation,
medical
record
genera
-
28
tion,
or
claim
coding
shall
disclose,
in
a
standardized
manner,
whether
29
such
tools
materially
assisted
in
the
preparation
of
a
claim
submitted
30
under
this
chapter.
31
(b)
Disclosure
pursuant
to
this
subsection
shall
be
limited
to
the
fact
32
of
use
of
such
tools
and
shall
not
require
disclosure
of
proprietary
33
systems,
algorithms,
prompts,
models,
workflows,
or
clinical
deci
-
34
sion
-
making
processes.
35
(c)
Use
of
automated
documentation
tools,
coding
assistance
tools,
36
artificial
intelligence,
or
similar
technologies
shall
not
relieve
a
37
practitioner
or
facility
of
responsibility
for
the
accuracy,
complete
-
38
ness,
and
truthfulness
of
information
submitted
in
a
claim.
39
(d)
An
insurer
shall
not
impose
additional
claim
submission
require
-
40
ments,
prepayment
review,
audits,
or
utilization
management
controls
41
solely
on
the
basis
that
a
practitioner
or
facility
disclosed
use
of
au
-
42
tomated
documentation
tools,
coding
assistance
tools,
artificial
in
-
43
telligence,
or
similar
technologies.
44
(e)
A
disclosure
made
pursuant
to
this
subsection
shall
not,
by
itself:
45
(i)
Constitute
a
material
defect
or
impropriety
in
a
claim;
46
(ii)
Create
a
presumption
of
fraud,
misrepresentation,
or
im
-
47
proper
billing;
48
(iii)
Justify
denial
of
a
claim,
delay
of
payment,
or
extension
of
49
statutory
time
frames
under
this
chapter;
or
50
8
(iv)
Permit
additional
documentation
requests
absent
a
specific,
1
articulated
inconsistency
reasonably
necessary
to
adjudicate
the
2
claim.
3
SECTION
9.
An
emergency
existing
therefor,
which
emergency
is
hereby
4
declared
to
exist,
this
act
shall
be
in
full
force
and
effect
on
and
after
5
July
1,
2026.
6