Legislation Detail

Insurers may not use AI as the sole basis to downcode or deny a claim on medical necessity grounds; a human employee or contractor must review the patient's medical record before AI-driven downcoding. Insurers must clearly disclose when AI is used to deny a prior authorization or downcode a claim. Providers may not use AI or automated tools to submit health benefit claims without review by a provider or another individual involved in preparing the claim. Also sets appeal requirements and limits retrospective audits and recoupments.

Health insurers and HMOs, health care providers (hospitals, physician groups, billing companies), and their AI/revenue-cycle vendors

iga.in.gov returned server errors/timeouts throughout this session, so the official page could not be read; substance confirmed by the Manatt tracker, the Indiana State Medical Association's July 9, 2026 e-report (https://www.ismanet.org/ISMA/Resources/e-Reports/7-9-26/New_Indiana_health_care_laws.aspx) and AI Law Tracker (Public Law 88).