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Private Review Agents; certain decisions with regard to the provision of insurance coverage for healthcare services shall not be based solely on artificial intelligence systems; provide
In one paragraph
Georgia Act 411, effective January 1, 2027, adds O.C.G.A. 33-46-7.1 for health insurance utilization review. Private review agents and utilization review entities may use AI and other software tools as part of a utilization review plan that meets state standards and Insurance Commissioner rules, including to automate tasks and take part in decisions. But no adverse determination may be issued to a patient until a natural person qualified as a private review agent or utilization review entity conducts a review in which a clinical peer participates, and AI may never supersede that clinical peer's judgment.
Plain-English summary, written with AI assistance. The official text controls.
What it means for business
From January 1, 2027, insurers and utilization review vendors in Georgia need human review with a clinical peer before any adverse determination, even when AI assists.
Key provisions
- Adds O.C.G.A. 33-46-7.1 (certification of private review agents), with definitions of 'artificial intelligence' and 'artificial intelligence system'
- AI and software tools allowed only as part of a utilization review plan meeting chapter 46 standards and the Insurance Commissioner's rules
- AI may automate tasks, reduce administrative burden and participate in decisions
- No adverse determination until a qualified natural person conducts a utilization review with a clinical peer
- AI may not supersede the clinical peer's judgment
- Signed May 5, 2026 (Act 411); effective January 1, 2027
Latest legislative action
May 5, 2026. Signed by the Governor (Act 411)
Sponsors
| Name | Role |
|---|---|
| Ben Watson | Primary |
| Ed Harbison | Primary |
| Kay Kirkpatrick | Primary |
| Larry Walker, III | Primary |
| Mike Hodges | Primary |
Topics and industries
Related topics
Affected industries
This page is general information, not legal advice. Summaries are AI-assisted and may contain errors; read the statute for the controlling text and talk to a lawyer about your situation. Full disclaimer · Report an error