Get emailed when this bill changes status, is amended, or advances.
Disclaimer: This page provides general informational summaries only and does not constitute legal advice. AI-generated content may contain errors. Always consult a qualified attorney for guidance specific to your situation.
Read full disclaimer →
This bill prohibits health insurers in Connecticut from using software tools, including AI, to automatically downcode health insurance claims without clinical review.
If you are a health insurer in Connecticut, you must ensure claims are reviewed by a clinical peer before any downcoding by now or face potential penalties.
State
Connecticut
Bill Number
SB817
Status
Introduced
Risk Level
Medium
Category
Comprehensive
Last Action
Jan 21, 2025
Last Verified
May 4, 2026
Data Updated
May 4, 2026
What do these statuses mean?▼
Introduced— Filed in the legislature; not yet heard in committee
In Committee— Assigned to and being reviewed by a legislative committee
Passed— Approved by one or both chambers; awaiting further action
Signed / Enacted— Signed into law by the governor; may or may not be in effect yet
Dead / Vetoed— Vetoed, failed to pass, or session expired without action
Unknown— Status data not yet available or awaiting classification
Connecticut's SB817 aims to regulate the use of software tools by health insurers, specifically targeting the automatic downcoding of health insurance claims. By mandating a detailed review by a clinical peer, the bill seeks to enhance oversight and protect healthcare providers from unjust claim denials. This legislation could impact how insurers process claims and the role of technology in these decisions.
Key Provisions
Prohibits health insurers from using software tools to downcode claims.
Requires detailed review by a clinical peer before any claim adjustments.
Applies to all health insurers operating in Connecticut.
Latest Legislative Action
Referred to Joint Committee on Insurance and Real Estate
Bill Sponsors
Name
Role
District
Herron GastonD
Sponsor
SD-023
Martin LooneyD
Sponsor
SD-011
Saud AnwarD
Sponsor
SD-003
Compliance Checklist
Ensure all claims are reviewed by a clinical peer before downcoding. Who: Health insurers in Connecticut Penalty: Potential operational challenges and reputational damage.
Full Legal Analysis
SB817 prohibits health insurers from utilizing any software tools, including artificial intelligence or algorithms, to automatically downcode or deny health insurance claims submitted by healthcare providers. The bill mandates that such claims must undergo a detailed review by a clinical peer before any adjustments can be made. This requirement aims to ensure that healthcare providers are treated fairly and that claims are not unjustly altered without proper oversight. Compliance will be necessary for all health insurers operating in Connecticut. The bill reflects a growing trend towards increased accountability in the use of technology within the healthcare sector, aligning with similar legislative efforts in other states to regulate automated decision-making processes in insurance.
We use cookies for analytics to understand how visitors use this site. We also use essential cookies for site functionality.
See our Privacy Policy for details.