Regulon.AI — NH-HB-1406 · NH HB 1406 (AI Provider Code Audits)

Summary

Prohibits New Hampshire health carriers from using artificial intelligence to conduct audits of provider codes or to adjust provider codes based on AI recommendations that would change, alter, or amend a provider's clinical judgment. Requires health carriers to maintain records identifying AI tool usage in claims processing and make those records available to the insurance department upon audit. Violations constitute unfair insurance practices under RSA 417, enforceable by the Insurance Commissioner through administrative fines or restitution orders. The bill is concise — a single operative section — and takes effect January 1, 2027.

Enforcement & Penalties

Enforcement Authority

The New Hampshire Insurance Commissioner has enforcement authority under RSA 417 (unfair insurance practices). Enforcement is agency-initiated through the insurance department's audit and administrative enforcement process. No private right of action is created by the statute.

Penalties

The commissioner may impose administrative fines or order restitution for any delay or denial of care resulting from a violation. No statutory minimum fine amount is specified in the bill itself; penalty amounts are governed by RSA 417 (unfair insurance practices). Restitution is available for delay or denial of care.

Who Is Covered

Compliance Obligations 3 obligations · click obligation ID to open requirement page

HC-01 Healthcare AI Decision Restrictions · HC-01.1 · Deployer · Healthcare

RSA 420-J:6-f

Plain Language

Health carriers may not use AI to audit provider billing codes or to adjust those codes based on AI recommendations if doing so would override, change, or amend the treating provider's clinical judgment. This is a categorical prohibition — not a disclosure-and-override regime. The definition of artificial intelligence is incorporated by reference to RSA 5-D:1. In practice, this means carriers cannot deploy AI-driven code-editing or downcoding tools that substitute algorithmic determinations for the provider's original clinical coding decisions.

Statutory Text

Health carriers are prohibited from using artificial intelligence, as defined in RSA 5-D:1, to conduct audits of provider codes or to adjust such codes based on recommendations from artificial intelligence that would change, alter, or amend the clinical judgment of a provider.

HC-01 Healthcare AI Decision Restrictions · HC-01.7 · Deployer · Healthcare

RSA 420-J:6-f

Plain Language

Health carriers must maintain records that specifically identify where and how AI tools are used in claims processing. These records must be made available to the New Hampshire Insurance Department upon audit. This is an ongoing recordkeeping obligation — carriers need systems to track and document AI tool usage across claims processing functions, not just at time of deployment but on a continuing basis. The records must be sufficient for the insurance department to verify compliance with the prohibition on AI-driven code adjustment.

Statutory Text

Each carrier shall maintain records identifying the use of artificial intelligence tools in claims processing and make such records available to the insurance department upon audit.

Other · Healthcare

RSA 420-J:6-f

Plain Language

Any violation of the AI code-auditing prohibition or the recordkeeping requirement constitutes an unfair insurance practice under New Hampshire's existing RSA 417 framework. The Insurance Commissioner may impose administrative fines or order restitution for delays or denials of care caused by the violation. This provision establishes the enforcement mechanism rather than creating a standalone compliance obligation.

Statutory Text

A violation of this section shall constitute an unfair insurance practice under RSA 417, and the commissioner may impose administrative fines or order restitution for any delay or denial of care resulting from such violation.