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 categories of claims, including those submitted for in-network and out-of-network providers, the number of claims denied and appealed, and the procedures for medical specialties with high denial rates. 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 bill also stipulates that payers must submit this data annually to the Department of Banking and Insurance, which will make it publicly available.

Furthermore, the bill establishes new 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 or medical director's claim 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.