{"data":{"id":"us-in/ic-27-1-52-9","jurisdiction":"us-in","citation":"IC 27-1-52-9","heading":"Limitation on use of automated process, system, or tool","body":"Sec. 9. (a) An insurer may not use an automated:\n(1) process;\n(2) system; or\n(3) tool, including artificial intelligence;\nas the sole basis to downcode a claim based on medical necessity without the review of the covered individual's medical record by an employee or contractor of the insurer.\n(b) A provider may not use an automated:\n(1) process;\n(2) system; or\n(3) tool, including artificial intelligence;\nto submit a health benefits claim without the review of a provider or other person involved in the development of the claim for submission.\n(c) An insurer must disclose in an easily accessible and readable manner when artificial intelligence is used to:\n(1) make an adverse determination on a prior authorization request; or\n(2) downcode a claim.","path":["TITLE 27. INSURANCE","ARTICLE 1. DEPARTMENT OF INSURANCE","Chapter 52. Downcoding of Health Benefits Claims"],"source_url":"https://iga.in.gov/ic/2026/Title_27.html#27-1-52-9","current_through":"2026","vintage":"2026","retrieved_at":"2026-09-25T05:39:04Z","sha256":"6e4c639f793aff7cd7030a7ec161f57cea8cc58d80f44d44097e800a8700850b","source_id":"us-in","stale":false,"prev":"us-in/ic-27-1-52-8","next":"us-in/ic-27-1-52-10"},"notice":"GroundRules: Original legal text. Not legal advice."}