This bill mandates that health insurers, referred to as payers, collect and publicly disclose specific data regarding health insurance claims and decisions made through automated utilization management systems. Payers are required to maintain records on various claim categories, including the number of claims denied and appealed, claims approved or denied during prior authorization, and the procedures of medical specialties with frequent claim denials. Additionally, if a payer unjustifiably denies at least 20% of claims in a year, they must reimburse the covered person for the denied services. The Department of Banking and Insurance will oversee the collection and public availability of this data.

Furthermore, the bill establishes new reporting requirements for utilization management processes. Every claim must be reviewed by a medical director, and payers must disclose their claim rejection rates and the average time taken to review claims on their websites. Denial notices must include the reviewing physician's denial rate and instructions for accessing consumer assistance. Health insurance carriers are also required to disclose whether they use automated utilization management systems and the number of claims reviewed by such systems. The Department of Banking and Insurance is granted the authority to audit these systems and the data collected by payers. The bill aims to enhance transparency and accountability in health insurance claims processing.