New California law prohibits using AI as (sole) basis to deny insurance claims

[Silent Type]

1. So, would that mean that Medicare can no longer deny claims for non-covered diagnoses, questionable services,

units/days/hours/etc that exceed traditional Medicare guidelines/requirements, high utilization providers, quack services, and other claims that have a high likelihood of wasting Medicare funds, that they’ve been doing since 1970s. That’s essentially what insurers are doing with AI, just like government programs.

Interestingly, I’ve seen recent ads touting AI to providers/doctors to help them manage claim denials by insurance companies.