Downcoding Reform Bill Clears Illinois Legislature on Unanimous Vote

The ISMS-backed bill would prohibit health insurance companies from automatically coding a health service at a level lower than what patients received.

CHICAGO, IL, UNITED STATES, May 29, 2026 /⁨EINPresswire.com⁩/ – The Illinois House passed Senate Bill 3114, the “Transparency in Downcoding Act,” by a vote of 111-0 Wednesday evening, following a unanimous vote out of the Senate earlier in the month. The bill, which would prohibit health insurance companies from automatically coding a health service at a level lower than what patients received, was supported by the Illinois State Medical Society (ISMS).

“This bill is another example of how Illinois leads the way in passing laws that improve access to medical care, making the state a more attractive place to practice medicine,” ISMS president Dr. Tripti Kataria said. “Once signed into law, the Transparency in Downcoding Act will bring greater clarity to the claims process, establish a clear and accessible pathway for disputing downcoded claims and ensure that a live person — not an automated system — is reviewing medical claims and their accompanying clinical documentation.”

“The Illinois State Medical Society wants to thank all lawmakers who stood with physicians and patients to support this bill as it passed the Senate unanimously. We especially thank sponsors Sen. Dave Koehler and Rep. Sharon Chung for their leadership, and we are hopeful that Gov. J.B. Pritzker will sign this bill into law as Illinois continues advancing policies that support patients and healthcare providers,” Dr. Kataria said.

Key Provisions of the Transparency in Downcoding Act (SB 3114):

• Prohibits a health insurance issuer from using an automated process, system, or tool to downcode a claim • Ensures that a live person — not an automated system — has done a complete and thorough review of claims and accompanying clinical documentation before a downcoding decision is made • Ensures that a physician will be clearly notified when a claim has been downcoded and reimbursed at a lower level, including the clinical reason for downcoding • Requires health insurers to establish a clear and accessible process for disputing downcoded claims. That means appeals must be reviewed by an individual with experience with the medical condition being managed and the services being downcoded using the most up to date AMA CPT® Coding Guideline, and • Prevents health insurers from using downcoding to discriminate against physicians who commonly treat patients with complex or chronic conditions.

Aaron Franco Illinois State Medical Society 312-580-6450