WHAT THIS BILL REGULATES · 2 REQUIREMENT TYPES
How Is This Bill Enforced
Verbatim statutory text on the left; plain-language analysis and a per-section checklist on the right. Numbered markers cross-link to the matching checklist row.
1 Health carriersHealth carrierThe bill does not independently define "health carrier" but uses the term as established in RSA 420-J (Managed Care Law). Health carriers subject to RSA 420-J include health maintenance organizations, insurers, and other entities providing managed care plans.RSA 420-J:6-f are prohibited from using artificial intelligenceArtificial intelligenceThe bill incorporates the definition of artificial intelligence by reference to RSA 5-D:1. The definition is not reproduced in the bill text.RSA 420-J:6-f (referencing RSA 5-D:1), as defined in RSA 5-D:1, to conduct audits of provider codes or to adjust such codes based on recommendations from artificial intelligenceArtificial intelligenceThe bill incorporates the definition of artificial intelligence by reference to RSA 5-D:1. The definition is not reproduced in the bill text.RSA 420-J:6-f (referencing RSA 5-D:1) that would change, alter, or amend the clinical judgment of a provider.
2 Each carrier shall maintain records identifying the use of artificial intelligenceArtificial intelligenceThe bill incorporates the definition of artificial intelligence by reference to RSA 5-D:1. The definition is not reproduced in the bill text.RSA 420-J:6-f (referencing RSA 5-D:1) tools in claims processing and make such records available to the insurance department upon audit.
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.
This new section inserted into RSA 420-J (Managed Care Law) creates three distinct obligations for health carriers. First, it categorically prohibits health carriers from using artificial intelligence to conduct audits of provider codes or to adjust codes based on AI recommendations that would change the clinical judgment of a provider. Second, it requires carriers to maintain records identifying AI tool use in claims processing and make those records available upon audit. Third, it designates violations as unfair insurance practices under RSA 417, authorizing administrative fines and restitution.
The prohibition is specifically targeted at AI-driven code auditing and code adjustment — a practice where insurers use AI to review and modify provider-submitted billing codes (CPT, ICD-10, etc.) in ways that effectively override the treating provider's clinical assessment of services rendered. The recordkeeping requirement ensures regulatory visibility into carrier AI use even where no violation has occurred.
This act shall take effect January 1, 2027.
This section establishes that the act takes effect January 1, 2027.