The proposed bill, if enacted, would amend current statutes by requiring health care providers to individually review each claim for health care services before a health care insurer can deny a claim or prior authorization, with specific exceptions for denials based on administrative completeness, member enrollment status, or categorical exclusions. Additionally, the bill prohibits the use of artificial intelligence in the denial process for claims or prior authorizations.

Furthermore, the bill classifies the denial of a claim or prior authorization without an individual review as unprofessional conduct. It also defines "health care provider" to include individuals certified or licensed under various specified titles and chapters of Arizona law. These updates aim to enhance accountability and transparency in the claims process within the health care system.

Statutes affected:
Introduced Version: 20-3103