The bill amends several sections of the Idaho Code to improve the prompt payment of claims by insurers and enhance the rights of healthcare practitioners and facilities. It introduces new definitions, such as "Claim" and "Complete claim," and establishes specific timelines for insurers to pay or deny claims—30 days for electronic claims and 45 days for paper claims. Insurers are also required to notify claimants if additional information is needed and must consolidate requests for information. The bill includes provisions for civil actions against insurers for violations, prohibits retaliatory conduct, and outlines penalties for noncompliance, including increased fines and potential suspension or revocation of an insurer's authority.

Additionally, the bill mandates transparency regarding the use of automated decision-making tools and artificial intelligence in claims processing, requiring both insurers and practitioners to disclose their use of such technologies. It ensures that these technologies do not relieve either party of their responsibilities for accurate and compliant claims. The new provisions will apply to all provider contracts for claims submitted on or after July 1, 2026, and existing contracts cannot waive these requirements. Overall, the bill aims to create a more efficient and fair claims process for beneficiaries and providers alike.

Statutes affected:
Bill Text: 41-5601, 41-5602, 41-5603, 41-5605, 41-5606