The bill amends the Prior Authorization Transparency Act to enhance the clarity and process surrounding adverse determination notices issued by utilization review entities. Key changes include the requirement for these entities to provide the name and license information of a physician who can discuss the adverse determination with the requesting healthcare provider. Additionally, if a healthcare provider submits an audio recording that demonstrates a violation of the notice requirements, the prior authorization will be deemed approved, and the utilization review entity must issue the authorization immediately.

Further amendments specify the information that must be included in both written and verbal notices of adverse determinations. This includes details about the reviewing physician's specialty, board certification, and a clear explanation of the basis for the adverse determination. The bill also outlines the process for subscribers to appeal adverse determinations and request reports related to their cases, ensuring that they are informed of their rights and the necessary steps to take in the appeals process.

Statutes affected:
Old version HB1700 V2 - 4-2-2025 11:44 AM: 23-99-1111(c), 23-99-1115(b), 23-99-1115
Old version HB1700 Original - 3-6-2025 01:21 PM: 23-99-1111(c), 23-99-1115(b), 23-99-1115
HB 1700: 23-99-1111(c), 23-99-1115(b), 23-99-1115
Act 638: 23-99-1111(c), 23-99-1115(b), 23-99-1115