Chung’s Transparency in Downcoding Act Becomes Law

​BLOOMINGTON, Ill. –  State Rep. Chung, D-Bloomington, championed a new law requiring more clarity when downcoding insurance claims. This clarity will allow local providers to stay in practice and protect patients from care coverage reductions.

“This issue was actually brought to me by a constituent, a local specialist. He shared how inadequate insurance coverage and coding could potentially price providers— especially the essential local providers that keep our community health— out of their practice,” said Chung.

Senate Bill 3114 creates new guidelines on insurance downcoding for both practitioners and patients. The law will ensure claim reviews are done manually, not by a computer algorithm or artificial intelligence, to ensure every facet of a patient’s case is taken into account.

If a claim is downcoded, the insurance company will inform physicians of the downcode and the clinical explanation. Insurance companies must also establish a clear process to dispute a downcoded claim.

“Technology is essential in health care, but not in the process of evaluating an insurance claim,” said Chung. “Requiring real people, not computer software, will ensure each patient is not just a claim number on a screen, but a valuable human life. Alternatively, a human reviewer can keep in mind the providers’ work in their specialization and their patient care.”

Senate Bill 3114 was signed into law earlier this month and is effective January 1, 2028.