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AI Summary
IL HB4735: TRANSPARENCY IN DOWNCODING ACT
Business Impact
If you are a health insurance issuer in Illinois, you must ensure downcoding decisions are made by licensed physicians or face penalties.
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
Affected Industries
Topics
What This Means
TRANSPARENCY IN DOWNCODING ACT — Track this IL bill and its compliance implications at AI Laws by State.
Key Provisions
- Prohibits automated downcoding of claims by health insurance issuers.
- Requires downcoding decisions to be made by licensed physicians.
- Mandates notification of downcoded claims with specific reasons and physician credentials.
- Establishes an appeal process for downcoded claims.
- Prohibits discriminatory downcoding practices against physicians treating complex conditions.
- Imposes penalties for violations, including fines, restitution, and license suspension.
Latest Legislative Action
Rule 19(a) / Re-referred to Rules Committee
Compliance Checklist
Ensure downcoding decisions are made by licensed physicians.
Who: Health insurance issuers.
Penalty: Fines up to $50,000 per violation.
Who: Health insurance issuers.
Penalty: Fines up to $50,000 per violation.
Provide clear notifications for downcoded claims.
Who: Health insurance issuers.
Penalty: Potential enforcement actions by the Department of Insurance.
Who: Health insurance issuers.
Penalty: Potential enforcement actions by the Department of Insurance.
Related & Companion Bills
Full Legal Analysis
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Official Bill Text
View HB4735 on official legislature website →
Related Topics
Affected Industries
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