Summary
Calls for federal and state requirements that health plans and third-party payers disclose to physicians and insured patients the clinical logic, evidence sources, and version history of AI or algorithmic tools used in adverse determinations and conduct reaudits after material changes plus comprehensive audits at least annually.
Healthcare Implications
Payers and vendors should maintain auditable documentation of decision logic, evidence, data and version changes; disclose relevant information with adverse determinations; and institute change-triggered and annual reviews to confirm alignment with current evidence-based guidelines and standards of care.