The bill amends the Prior Authorization Transparency Act to enhance the privacy of reviewing physicians involved in adverse determinations. Specifically, it removes the requirement for utilization review entities to disclose the name of the reviewing physician in the adverse determination notice. Instead, the bill mandates that the physician must disclose their name and license information to the requesting healthcare provider upon contact. Additionally, the written and verbal notices of adverse determinations will now include the specialty or practice area of the reviewing physician, along with their board certification status, but will not include their name or license number in the notice itself.

Furthermore, the bill introduces new provisions that require utilization review entities to provide subscribers with clear explanations of the basis for adverse determinations, including clinical criteria and internal guidelines used in the decision-making process. It also outlines the procedures for subscribers to request reports related to the review and details their rights to appeal adverse determinations. Importantly, the bill emphasizes that the name and license number of the reviewing physician will not be disclosed in any written notice to healthcare providers or subscribers, thereby enhancing confidentiality in the review process.

Statutes affected:
Old version HB1700 Original - 3-6-2025 01:21 PM: 23-99-1111(c), 23-99-1115(b), 23-99-1115
Old version HB1700 V2 - 4-2-2025 11:44 AM: 23-99-1111(c), 23-99-1115(b), 23-99-1115
HB 1700: 23-99-1111(c), 23-99-1115(b), 23-99-1115