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1 New Section; Managed Care Law; Use of Artificial Intelligence to Change the Clinical Judgment of the Provider Prohibited. Amend RSA 420-J by inserting after section 6-e the following new section:
420-J:6-f Use of Artificial Intelligence by Health Carriers to Change Provider Codes Prohibited. Health carriers are prohibited from using artificial intelligence, as defined in RSA 5-D:1, to conduct audits of provider codes or to adjust such codes based on recommendations from artificial intelligence that would change, alter, or amend the clinical judgment of a provider. Each carrier shall maintain records identifying the use of artificial intelligence tools in claims processing and make such records available to the insurance department upon audit. A violation of this section shall constitute an unfair insurance practice under RSA 417, and the commissioner may impose administrative fines or order restitution for any delay or denial of care resulting from such violation.
2 Effective Date. This act shall take effect January 1, 2027.
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1 New Section; Managed Care Law; Use of Artificial Intelligence to Change the Clinical Judgment of the Provider Prohibited. Amend RSA 420-J by inserting after section 6-e the following new section:
420-J:6-f Use of Artificial Intelligence by Health Carriers to Change Provider Codes Prohibited. Health carriers are prohibited from using artificial intelligence, as defined in RSA 5-D:1, to conduct audits of provider codes or to adjust such codes based on recommendations from artificial intelligence that would change, alter, or amend the clinical judgment of a provider. Each carrier shall maintain records identifying the use of artificial intelligence tools in claims processing and make such records available to the insurance department upon audit. A violation of this section shall constitute an unfair insurance practice under RSA 417, and the commissioner may impose administrative fines or order restitution for any delay or denial of care resulting from such violation.
2 Effective Date. This act shall take effect January 1, 2027.