This bill proposes updates to current statutes regarding the denial of claims and prior authorizations by health care insurers. Specifically, it mandates that before a health care insurer can deny a claim based on medical necessity, the medical director must individually review the denial and exercise independent medical judgment, without relying solely on external recommendations. This requirement is similarly applied to direct denials of prior authorizations involving medical necessity.

Additionally, the bill introduces new sections to the Arizona Revised Statutes, specifically adding sections 20-3103 and 20-3407, which outline these requirements. The effective date for these changes is set for July 1, 2026. Overall, the bill aims to enhance the review process for claims and prior authorizations, ensuring that decisions are made with thorough individual assessment by qualified medical directors.

Statutes affected:
Introduced Version: 20-3103
House Engrossed Version: 20-3103
Senate Engrossed Version: 20-3103, 20-3407
Chaptered Version: 20-3103, 20-3407