Nebraska § 44-5443 Artificial intelligence-based algorithm; use; restrictions; automated utilization management system; audit

Nebraska Statutes

§ 44-5443 — Artificial intelligence-based algorithm; use; restrictions; automated utilization management system; audit

Nebraska·Ch. 44 Insurance

(1)An artificial intelligence-based algorithm shall not be the sole basis of a utilization review agent's decision to deny, delay, or modify health care services based, in whole or in part, on medical necessity.

(2)A utilization review agent shall disclose to the department, to each health care provider in its network, to each enrollee, and on its public website if artificial intelligence-based algorithms are used or will be used in the utilization review process.

(3)The department may, at any time, audit a utilization review agent's automated utilization management system. The department may contract with a third-party entity to perform an audit pursuant to this section.

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(1) An artificial intelligence-based algorithm shall not be the sole basis of a utilization review agent's decision to deny, delay, or modify health care services based, in whole or in part, on medical necessity.
(2) A utilization review agent shall disclose to the department, to each health care provider in its network, to each enrollee, and on its public website if artificial intelligence-based algorithms are used or will be used in the utilization review process.
(3) The department may, at any time, audit a utilization review agent's automated utilization management system. The department may contract with a third-party entity to perform an audit pursuant to this section.

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