Illinois Physicians Applaud Gov. Pritzker’s Signing of Downcoding Reform Legislation

The health insurer tactic of automatic downcoding will be restricted, thanks to the Illinois governor's signing of Senate Bill 3114 into law.

CHICAGO, IL, UNITED STATES, July 13, 2026 /EINPresswire.com/ -- The Illinois State Medical Society (ISMS) applauds Gov. J.B. Pritzker for signing the Transparency in Downcoding Act into law after it passed unanimously in both chambers of the General Assembly.

This landmark legislation directly addresses the health insurer practice of using automated systems to reduce physician reimbursement without reviewing clinical documentation.

"Illinois is leading the way in protecting the patient-physician relationship and ensuring that clinical expertise — not a computer algorithm — dictates the level of care provided,” ISMS president Dr. Tripti Kataria said. “These new guardrails will help preserve the financial viability of our state's medical practices and secure continued access to quality healthcare for all Illinoisans.”

ISMS thanks Sen. Dave Koehler, Rep. Sharon Chung, Rep. Jeff Keicher and Rep. Bill Hauter for sponsoring and advocating for this important legislation.

To learn more about the impact of downcoding on physicians, read the 2026 ISMS downcoding survey report here.

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 — will be reviewing the submitted claims and must refer to the most up to date AMA CPT^® Coding Guideline prior to downcoding the claim
• 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
+1 3125806450
email us here

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