Law / United States / Indiana
Downcoding of Health Benefits Claims, automated and AI decision-making (House Enrolled Act 1271, 2026)
A citation is an address, not a summary. The first part names the law; what follows narrows it to the exact section, article or paragraph.
In force 77 days, effective 1 July 2026.
An AI risk obligations rule binding private bodies.
As of 6 September 2026.
What it requires
- Do not use an automated process, system, or tool, including artificial intelligence, as the sole basis to downcode a health benefits claim based on medical necessity, unless an employee or contractor has first reviewed the covered individual's medical record
- Disclose, in an easily accessible and readable manner, whenever artificial intelligence is used to make an adverse determination on a prior authorization request or to downcode a claim
- This chapter does not reach claims under the Medicaid program or a Medicaid managed care organization
If you get it wrong
Criminal exposureNo
Private right of actionNo
What it reaches
Obligation class
Disclosure, Governance
What this law does
Drafted with AI from the cited sources under the direction of UnGovr staff. UnGovr holds editorial responsibility for this page.
A new Indiana Code chapter on downcoding of health benefits claims bars a health insurer, HMO, or dental preferred-provider plan from using an automated process, system, or tool, including artificial intelligence, as the sole basis to downcode a claim based on medical necessity, without a covered individual's medical record first being reviewed by an insurer employee or contractor; it likewise bars a provider from submitting a claim through such an automated tool without human review.
The insurer must disclose, in an easily accessible and readable manner, whenever artificial intelligence is used to make an adverse determination on a prior authorization request or to downcode a claim. The chapter does not apply to the Medicaid program or a Medicaid managed care organization. Enacted as House Enrolled Act 1271, it took effect July 1, 2026 under the act's own effective-date clause.
When LexLint raises it
high_risk_decisions