OR HB4054: Relating to downcoding.

In one paragraph

Not law. Oregon HB 4054 (2026) would have required health insurers that provide utilization review to tell a provider in writing, within two business days after payment, when AI, an algorithm or other software automatically downcoded a claim, giving the reason and appeal rights, and would have given providers a timely appeal. It had a public hearing in the Information Management and Technology committee and was in committee upon adjournment March 6, 2026.

Plain-English summary, written with AI assistance. The official text controls.

What it means for business

None: the bill died and never became law. It would have bound health insurers using AI to downcode provider claims.

Key provisions

1. 1Covers all insurers offering a health benefit plan in Oregon that provide utilization review or have it provided on their behalf (ORS 743B.423)
2. 2Downcode: change a claim's billing code to one with a lower reimbursement rate
3. 3Written notice to the provider no later than two business days after payment when AI or other software automatically downcodes, stating the tool's use, the specific reason, appeal process and time limits, and citing any policy language relied on
4. 4Providers would get a timely appeal of an automatic downcode before an appropriate medical consultant or peer review committee, consistent with ORS 743B.453
5. 5Would apply to plans issued, renewed or extended on or after the act's effective date; no penalty provisions in the text
6. 6Referred to Information Management and Technology; public hearing February 6, 2026; in committee upon adjournment March 6, 2026; not enacted

Latest legislative action

Mar 6, 2026. In committee upon adjournment.

Amendments (1)

• Joint Committee On Information Management and Technology Amendment #-1 Not adopted 2026-02-06