Law / United States / 
Indiana
Downcoding of Health Benefits Claims, automated and AI decision-making (House Enrolled Act 1271, 2026)
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What follows is LexLint's own research summary of this law, not legal advice.
In force 84 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 it makes you log
Logging duty
Section 9(a) requires an employee or contractor to review the covered individual's medical record before an automated tool may be the sole basis for a downcode; section 9(c) requires the insurer to disclose when artificial intelligence is used to make an adverse determination or to downcode a claim; and section 11 requires the insurer to notify the provider of the specific reason, the clinical criteria and the original and revised codes and payment amounts whenever a claim is downcoded. Each of these is a point-in-time disclosure or process condition tied to the claim transaction itself; no section of this chapter requires the insurer to keep, document or later produce a record of the review or the disclosure, and none gives a regulator, court or auditor a route to demand one.
- Kind
- None
- As of
- 21 September 2026
Who checks it
Audit expectation
none
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
Read the law
official enrolled act text, Indiana General Assembly
Every line above is drawn from the primary source linked here, read on the date shown. This is a research summary, not legal advice.